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Giordano F, Salimbeni CT, Jefferies P. The Tutor of Resilience Program with Children Who Have Experienced Maltreatment: Mothers' Involvement Matters. Child Psychiatry Hum Dev 2024; 55:295-307. [PMID: 35916984 PMCID: PMC10891266 DOI: 10.1007/s10578-022-01393-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/03/2022]
Abstract
Resilience is a dynamic process involving the presence and interaction of personal and environmental factors that modify the impact of adversity. Resilience-building interventions are therefore important for improving trauma-related outcomes in children and caregivers exposed to adversity. This study examines the impact of the Tutor of Resilience (TOR) program on beneficiaries' trauma-related symptoms and on mother-child interactions in a group of children exposed to maltreatment (N = 186; mean age = 11.95; SD = 2.50). Assessments were completed at baseline and post-intervention. RM-ANOVAs indicated significant improvements for most trauma symptoms (anxiety, anger, post-traumatic stress, and disassociation, but not depression) in the intervention group relative to a control group (N = 88; mean age = 10.76; SD = 2.57), and indicated further improvements to anxiety and dissociation for the intervention group when mothers were involved. Mother-child interactions also improved over time, as did their overall trauma symptoms and distress. Findings support the effectiveness of the ToR, especially when involving mothers.
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Affiliation(s)
- F Giordano
- Department of Psychology - Resilience Research Unit, Università Cattolica del Sacro Cuore Largo Gemelli 1, Milan, MI, 20121, Italy.
| | - C Taurelli Salimbeni
- Department of Psychology - Resilience Research Unit, Università Cattolica del Sacro Cuore Largo Gemelli 1, Milan, MI, 20121, Italy
| | - P Jefferies
- Family and Community Resilience, Canada Research Chair in Child, Resilience Research Centre Dalhousie University, PO Box 15000, Halifax, NS, B3H4R2, Canada
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Benight CC, Hurd JA, Morison M, Ricca BP. Big ideas series: self-regulation shift theory: trauma, suicide, and violence. ANXIETY, STRESS, AND COPING 2024; 37:1-15. [PMID: 37555655 DOI: 10.1080/10615806.2023.2242281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 02/14/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Traumatic stress, suicide, and impulsive violence arguably are three of the most consequential problems facing societies today. Self-regulation shift theory is introduced to capture the underlying coping dynamics involved in these three grave challenges. OBJECTIVES Self-regulation shift theory, based in a nonlinear dynamical systems framework, focuses on critical psychological self-regulation thresholds and the role of cognitive self-appraisals in human adaptation to help understand these three significant societal challenges. METHODS This essay reviews existing evidence within the posttraumatic adaptation process utilizing SRST for understanding dynamic self-regulation. This is followed by integrating SRST within existing current theoretical models for suicidal behaviors and violent outbursts. CONCLUSIONS The essay concludes with methodological suggestions for future research applying SRST and how this research offers important opportunities to develop early warning systems that promote hope when hope seems impossible.
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Affiliation(s)
- Charles C Benight
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, USA
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, USA
| | - Julie A Hurd
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, USA
| | - Margaret Morison
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, USA
| | - Bernard P Ricca
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, USA
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Hu W, Deng C. The effect of duration of youth/parent communication on depression and anxiety during COVID-19 isolation in China. SCHOOL PSYCHOLOGY INTERNATIONAL 2023; 44:468-488. [PMID: 38603409 PMCID: PMC9729717 DOI: 10.1177/01430343221142284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The current study examines the mediating roles of self-efficacy and sleep disturbance and the moderating role of gender in the association between the duration of youth/parent communication on depression and anxiety during the COVID-19 isolation period in China. We used the self-designed demographic variable questionnaire, General Self-Efficacy Scale, the Pittsburgh Sleep Quality Index, the Self-Rating Depression Scale, and the Self-Rating Anxiety Scale with 1,772 youths aged 15-24 from 26 provinces in China during the COVID-19 lockdown. We performed demographic variable analysis, correlation analysis, mediation analysis, and moderated analysis. The duration of daily communication with parents was significantly positively correlated with self-efficacy and significantly negatively correlated with sleep disturbance, depression, and anxiety. The chain mediation analysis revealed that the duration of communication with parents directly affected depression and anxiety. Self-efficacy, sleep disturbance, and self-efficacy sleep disturbance had significant mediating and chain-mediating effects on the duration of communication with parents, depression, and anxiety. The interactions between sleep disturbance and gender (B = 0.35, 95% CI 0.06 to 0.64, p = .02 < .05) were significant. The duration of parent/youth communication directly affected depression and anxiety and indirectly affected depression and anxiety via the chain-mediating effect of self-efficacy and sleep disturbance. Gender moderates the relationships between sleep disturbance and depression.
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Affiliation(s)
- Weijian Hu
- Department of Mental Health, Guangzhou College of Technology and Business, Guangzhou, China
| | - Cuiyun Deng
- Department of Mental Health, Guangzhou College of Technology and Business, Guangzhou, China
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Di W, Nie Y, Chua BL, Chye S, Teo T. Developing a Single-Item General Self-Efficacy Scale: An Initial Study. JOURNAL OF PSYCHOEDUCATIONAL ASSESSMENT 2023. [DOI: 10.1177/07342829231161884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
General self-efficacy represents the global sense of personal capability across various situations and tasks. The aim of the present study was to develop and validate a single-item general self-efficacy scale which balances practical demands and psychometric concerns. The psychometric properties of the proposed Single-Item General Self-Efficacy Scale (GSE-SI) were examined among 231 Singaporean adults. Results based on three statistical methods demonstrated good reliability (.594 .607 and .726, respectively, M = .642), as compared with the reliability scores from other single-item scales. It also showed satisfactory criterion-related validity evidence (i.e., correlation with a multiple-item general self-efficacy scale, r = .795). Validity evidence based on relationships with other constructs was supported by the correlations between the scores of general self-efficacy and the scores of six relevant constructs (i.e., positive correlations with life satisfaction and positive emotions, negative correlations with negative emotions, task and perceived stress, and illness symptoms). More importantly, the GSE-SI and multiple-item scale scores showed consistent correlation patterns with their relevant constructs. Both GSE-SI and multiple-item scale scores significantly discriminated between the three clusters in a similar pattern. The present results show that the GSE-SI is a reliable and valid measure of general self-efficacy and can be recommended in future research to complement the constraints of multiple-item scales.
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Affiliation(s)
- Weiwei Di
- Nanyang Technological University, Singapore
| | - Youyan Nie
- Nanyang Technological University, Singapore
| | | | | | - Timothy Teo
- Chinese University of Hong Kong School of Education, Hong Kong
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Kowalchyk M, Chernoff E, Brinkman HR, Brown AD, Pietrzak RH, Feder A. Perceived social support moderates the relation between forward-focused coping and PTSD symptoms in World Trade Center trauma survivors. J Psychiatr Res 2023; 159:130-134. [PMID: 36708637 DOI: 10.1016/j.jpsychires.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/04/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Social support and perceived ability to cope with trauma have been linked to severity of PTSD symptoms. While previous literature has highlighted the influence of trauma coping style on PTSD severity, data are lacking regarding factors that may moderate this association. Such information may help inform more personalized treatments for PTSD. Toward this end, we analyzed data from 100 treatment-seeking WTC responders and survivors with full or subthreshold World Trade Center (WTC)-related PTSD who completed measures of perceived ability to cope with trauma and perceived social support prior to treatment initiation. Correlation analyses revealed that higher forward-focused perceived ability to cope (r = -0.24) and perceived social support (r = -0.32) were each associated with lower severity of PTSD symptoms. In a multivariable regression analysis, perceived social support emerged as a significant moderator of the relation between forward-focused coping and overall PTSD symptom severity (β = -0.36). Specifically, among individuals with higher forward-focused coping, those with higher social support had lower severity of symptoms than those with lower social support. Results suggest that interventions to bolster social support among trauma survivors with a forward-focusing coping style may help mitigate severity of PTSD symptoms in treatment-seeking trauma survivors with PTSD symptoms.
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Affiliation(s)
- Mary Kowalchyk
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eva Chernoff
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannah R Brinkman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adam D Brown
- Department of Psychology, The New School for Social Research, New York, NY, USA; Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Nickerson A, Hoffman J, Keegan D, Kashyap S, Tricesaria D, Pestalozzi Z, Argadianti Rachmah R, Nandyatama R, Khakbaz M, Nilasari N, Liddell BJ. Context, coping, and mental health in refugees living in protracted displacement. J Trauma Stress 2022; 35:1769-1782. [PMID: 36268717 DOI: 10.1002/jts.22885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/24/2022]
Abstract
There is currently an unprecedented number of forcibly displaced people worldwide. Little is known, however, about how external stressors and internal coping strategies intersect to influence mental health in displaced refugees, particularly whether specific types of coping strategies are more or less effective across different levels of external stress. This study aimed to understand whether positive and negative internal coping strategies were differentially associated with mental health across high and low levels of external stressors in displaced refugees. Participants were 1,216 refugees living in Indonesia who completed an online survey indexing demographic characteristics, exposure to ongoing stressors, positive psychological coping strategies (i.e., cognitive flexibility, self-efficacy, and hope), negative psychological coping strategies (i.e., rumination and intolerance of uncertainty), psychological symptoms (i.e., posttraumatic stress disorder, depression, and anxiety) and mental health-related quality of life. Participants (27.3% female, Mage = 30.52 years) were from Arabic-, Farsi-, Tamil-, Somali-, Dari-, and English-speaking backgrounds. Results of latent moderated structural equation modeling indicated that the association between negative psychological coping strategies and poorer mental health was stronger at higher levels of stress, whereas the association between positive psychological coping strategies and better quality of life was stronger at lower levels of stress. These findings provide evidence in support of tailored approaches that integrate interventions addressing external stressors and internal coping strategies to support positive mental health and enhanced quality of life in displaced refugees.
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Affiliation(s)
- Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Joel Hoffman
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Shraddha Kashyap
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Zico Pestalozzi
- SUAKA, Indonesian Civil Society Network for Refugee Rights Protection, Jakarta, Indonesia
| | - Rizka Argadianti Rachmah
- HOST International, Parramatta, Australia.,SUAKA, Indonesian Civil Society Network for Refugee Rights Protection, Jakarta, Indonesia
| | - Randy Nandyatama
- School of International Relations, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Nindita Nilasari
- School of International Relations, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, Sydney, Australia
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Blackwell MA, Lardier DT, Choe R, Goodkind JR. Geocultural variation in correlates of psychological distress among refugees resettled in the United States. J Trauma Stress 2022; 35:1472-1483. [PMID: 35729776 DOI: 10.1002/jts.22853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 11/11/2022]
Abstract
Attention to cultural variability in mental health symptoms could inform intervention targets; however, this is currently a neglected area of study. This study examined whether the associations between common mental health disorder (CMD) symptoms and predictors of CMDs varied cross-culturally. Participants were 290 refugees from three geocultural regions (Afghanistan, Great Lakes region of Africa, and Iraq and Syria) who recently resettled in the United States and completed assessments of CMD symptoms and predictors. Multilevel generalized linear modeling was used to examine the interactions between correlates of depressive, anxiety, and posttraumatic stress disorder (PTSD) symptoms and each of the three cultural reference groups. Relative to refugees from other regions, Iraqi and Syrian participants demonstrated stronger associations between the number of reported traumatic experiences and both depressive, B = 0.01, SE = .003, p = .003, and anxiety symptoms, B = 0.01, SE = .003, p < .001; Afghan participants showed a stronger association between physical quality of life and PTSD symptoms, B = 0.02, SE = .011, p = .037; and African participants demonstrated stronger associations between gender and symptoms of all three CMDs, Bs = 0.11-.020, SEs = .04-.06, ps = .005-.008, and weaker associations between traumatic event exposure and CMD symptoms, Bs = -0.01--0.02, SEs = .003-.006, ps = .000-.002. CMD symptoms likely present differently across cultures, with various predictors more salient depending on cultural backgrounds and differential experiences that vary based on context. These findings have implications for cross-cultural assessment research and mental health.
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Affiliation(s)
- Meredith A Blackwell
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - David T Lardier
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Ryeora Choe
- Department of Sociology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jessica R Goodkind
- Department of Sociology, University of New Mexico, Albuquerque, New Mexico, USA
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Al-Hamad A, Forchuk C, Oudshoorn A, Mckinley GP. Listening to the Voices of Syrian Refugee Women in Canada: an Ethnographic Insight into the Journey from Trauma to Adaptation. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2022; 24:1-21. [PMID: 36186909 PMCID: PMC9510543 DOI: 10.1007/s12134-022-00991-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 11/15/2022]
Abstract
Syrian refugee women face many obstacles when accessing health services in host countries that are influenced by various cultural, structural, and practical factors. This paper is based on critical ethnographic research undertaken in Canada, to explore Syrian refugee women migration experiences. Also, we aim at critically examining how the intersection of gender, trauma, and violence, and the political and economic conditions of Syrian refugee women shapes their everyday lives and health. The study also investigates the strategies and practices by which Syrian refugee women are currently addressing their healthcare needs and the models of care that are suggested for meeting their physical and mental health needs. Findings show that these women experienced constant worries, hardship, vulnerability, and intrusion of dignity. These experiences and challenges were aggravated by the structure of the Canadian social and healthcare system. This study offers a better understanding of the impact of migration and trauma on Syrian refugee women's roles, responsibilities, gender dynamics, and interaction with Ontario's healthcare system to improve interaction and outcomes. Healthcare models should address these challenges among Syrian refugee families in Canada.
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Affiliation(s)
- Areej Al-Hamad
- Daphne Cockwell School of Nursing, Faculty of Community Services, DCC544, Toronto Metropolitan University, 288 Church St., Toronto, M5B 1Z5 Canada
| | - Cheryl Forchuk
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, FIMS & Nursing Building Room 2356, London, ON N6A 5B9 Canada
| | - Abe Oudshoorn
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, FIMS & Nursing Building Room 2356, London, ON N6A 5B9 Canada
| | - Gerald Patrick Mckinley
- Western Centre for Public Health and Family Medicine, Western University, Room 4115, London, ON N6A 5B9 Canada
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Kheirallah KA, Al-Zureikat SH, Al-Mistarehi AH, Alsulaiman JW, AlQudah M, Khassawneh AH, Lorettu L, Bellizzi S, Mzayek F, Elbarazi I, Serlin IA. The Association of Conflict-Related Trauma with Markers of Mental Health Among Syrian Refugee Women: The Role of Social Support and Post-Traumatic Growth. Int J Womens Health 2022; 14:1251-1266. [PMID: 36092127 PMCID: PMC9462433 DOI: 10.2147/ijwh.s360465] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Syrian refugee women not only suffered the refuging journey but also faced the burden of being the heads of their households in a new community. We aimed to investigate the mental health status, traumatic history, social support, and post-traumatic growth (PTG) of Syrian refugee women. Methods A cross-sectional study was conducted using a structured interviewer-administered survey between August and November 2019. Syrian refugee women who head their households and live outside camps were eligible. The survey included items investigating socio-demographic characteristics and conflict-related physical trauma history. The Refugee Health Screener-15 (RHS-15) scale was used to screen for emotional distress symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD), with a score range of 0−4 and higher scores indicating emotional distress. The Multidimensional Scale of Perceived Social Support (MSPSS) was utilized to assess the perceived support from family, friends, and significant others (score range 1−7), with scores of 3−5 and 5.1−7.0 representing moderate and high support, respectively. The PTG Inventory (PTGI) scale investigated the positive transformation following trauma; the score range was 0−5, and the cutoff point of ≥3 defined moderate-to-high growth levels. Results Out of 140 invited refugee women, 95 were included, with a response rate of 67.9%. Their mean (SD) age was 41.30 (11.75) years, 50.5% were widowed, and 17.9% reported their husbands as missing persons. High levels of conflict-related traumatic exposure were found, including threats of personal death (94.7%), physical injury (92.6%), or both (92.6%); and a history of family member death (92.6%), missing (71.6%), or injury (53.7%). The mean (SD) RHS-15 score was above average (2.08 (0.46)), and most women (90.5%) were at high risk for depression, anxiety, and PTSD symptoms. The mean (SD) MSPSS score was 5.08 (0.71), representing moderate social support, with friends’ support being the highest (5.23 (0.85)). The mean (SD) PTGI score was 2.44 (0.48), indicating low growth, with only 12.6% of women experiencing moderate-to-high growth levels. Spiritual change and personal strength had the highest sub-scores, with moderate-to-high growth levels experienced by 97.9% and 84.2%, respectively. Most women were more optimistic and religious, had feelings of self-reliance and better difficulties adapting, and were stronger than they thought. Statistically significant correlations of MSPSS and its subscales with RHS-15 and PTGI were detected. Conclusion Significant but unspoken mental health problems were highly prevalent among Syrian refugee women and an imminent need for psychological support to overcome traumatic exposure. The role of social support seems to be prominent and needs further investigation.
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Affiliation(s)
- Khalid A Kheirallah
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sarah H Al-Zureikat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Mohammad AlQudah
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Adi H Khassawneh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Saverio Bellizzi
- World Health Organization (WHO), Jordan Country Office, Amman, Jordan
| | - Fawaz Mzayek
- School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ilene A Serlin
- International Institute for Advanced Training in Dance Movement Therapy, San Francisco, CA, USA
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Sá FHDL, Waikamp V, Freitas LHM, Baeza FLC. Mental health outcomes in Syrian refugees: A systematic review. Int J Soc Psychiatry 2022; 68:933-953. [PMID: 35657322 DOI: 10.1177/00207640221099404] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Syria is the main country of origin for refugees in the world. The prevalence of mental disorders in this population is high, but there is a lack of more comprehensive data on mental health issues in this population. AIM This study aims to review the literature for mental health outcomes in Syrian refugees. METHODS We performed a systematic quantitative literature review of original observational studies indexed on the MEDLINE via PubMed, Embase, Web of Science, PsycINFO, LILACS, and SciELO databases with quantitative data reporting mental health outcomes in Syrian refugees. A descriptive analysis was conducted, and the quality of the included studies was assessed using an adaptation from The National Institutes of Health (NIH) quality assessment tool for observational studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. RESULTS A total of 64 studies were included. The majority were published between 2019 and 2020, and focused on the prevalence of post-traumatic stress disorder (PTSD), depression, and anxiety, with a wide range of variations. Other outcomes were difficulties in the post-migration period and promotive factors for mental health, such as resilience, positive coping strategies, and psychosocial well-being. CONCLUSIONS High prevalence rates of mental disorders were observed, as well as risk factors for their occurrence. Studies showed a very high variability of prevalence rates and heterogeneity in methodologies. There is a need for research focusing on other determinants and specific necessities for mental health, especially in the post-resettlement period.
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Affiliation(s)
- Fernando Henrique de Lima Sá
- Post-Graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Porto Alegre, Brazil
| | - Vitória Waikamp
- Post-Graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Porto Alegre, Brazil
| | - Lúcia Helena Machado Freitas
- Post-Graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Porto Alegre, Brazil.,Clinical Hospital of Porto Alegre, Rio Grande do Sul, Brazil
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Wang N, Chung MC, Zhang J, Fang S. Network analysis on the relationship between posttraumatic stress disorder, psychiatric co-morbidity and posttraumatic growth among Chinese adolescents. J Affect Disord 2022; 309:461-470. [PMID: 35513114 DOI: 10.1016/j.jad.2022.04.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/14/2021] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study investigated the association between posttraumatic stress disorder (PTSD), psychiatric co-morbidity and posttraumatic growth (PTG) among Chinese adolescents using network analysis. METHODS 867 Chinese adolescents (male = 424, female = 443) were recruited from three secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Posttraumatic Growth Inventory, and the General Health Questionnaire-28. RESULTS Domains of each construct mainly clustered within their respective communities with several bridging edges identified. The prominent roles of bridging nodes and edges (positive and negative) were highlighted. Key bridging nodes were negative alterations in cognitions and mood for PTSD, anxiety and insomnia for psychiatric co-morbidity and appreciation of life for PTG. LIMITATIONS The cross-sectional nature of the present study may preclude the identification of real causal relationships between nodes. CONCLUSIONS Following a trauma, adolescents displayed posttraumatic stress along with general psychological disorder symptoms. These distress reactions could affect the way they appreciated life and their motivation to seek future life possibilities. Findings from the current study may provide some clue for the facilitation of posttraumatic growth among clinical patients.
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Affiliation(s)
- Na Wang
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong
| | - Man Cheung Chung
- Department of Psychology, Zayed University, Dubai, United Arab Emirates
| | - Jieting Zhang
- College of Psychology, Shenzhen University, Shenzhen, China
| | - Siqi Fang
- Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong.
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12
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Wang N, Chung MC, Liu F, Wang Y. Posttraumatic stress on Chinese adolescents’ posttraumatic growth: The role of trauma centrality and emotion regulation. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03131-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Vermeulen M, Smits D, Claes L, Gandhi A, Raes F, Krans J. The Dutch 20 Item Centrality of Event Scale. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2022. [DOI: 10.1027/1015-5759/a000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Event centrality is defined as the extent to which a memory of a traumatic event forms a reference point for people’s identity and attribution of meaning to other experiences in their life. Event centrality is typically measured with the Centrality of Event Scale (CES; Berntsen & Rubin, 2006 ). The present study’s first aim was to investigate the underlying factor structure and construct validity of the Dutch 20-item CES (CES-20) in undergraduates ( N = 1,091). The second aim was to test whether the CES-20 could prospectively predict posttraumatic stress disorder (PTSD) symptoms four months later. The data supported a one-factor structure of the CES with a high internal consistency (α = .95), which is not in line with the theoretical model of event centrality but aligns with previous empirical research. Furthermore, high construct validity was evidenced by positive and significant relations between the CES and PTSD symptoms, depressive symptoms, DSM-5 trauma A criterion, and the number of experienced negative life events. Event centrality was not a significant predictor of PTSD symptoms four months later when controlling for PTSD symptoms at time 1, which questions the prospective relation between event centrality and later PTSD symptoms for those events.
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Affiliation(s)
| | - Dirk Smits
- Behavior, Health and Psychopathology, KU Leuven, Belgium
- Odisee, University of Applied Sciences, Brussels, Belgium
| | - Laurence Claes
- Behavior, Health and Psychopathology, KU Leuven, Belgium
- Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Belgium
| | - Amarendra Gandhi
- L-BioStat, Department of Public Health and Primary Care, KU Leuven, Belgium
- Knowledge Center, SD Worx, Antwerp, Belgium
| | - Filip Raes
- Behavior, Health and Psychopathology, KU Leuven, Belgium
| | - Julie Krans
- Behavior, Health and Psychopathology, KU Leuven, Belgium
- Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
- Pro Persona Overwaal Centre for Anxiety, OCD and PTSD, Nijmegen, The Netherlands
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Chung MC, Shakra M. The Association Between Trauma Centrality and Posttraumatic Stress Among Syrian Refugees: The Impact of Cognitive Distortions and Trauma-Coping Self-Efficacy. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:1852-1877. [PMID: 32515293 DOI: 10.1177/0886260520926311] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
While research suggests that the war in Syria has led to a drastic re-evaluation of oneself and elevated psychiatric symptoms among Syrian refugees, little is known whether these psychological reactions might be influenced by maladaptive beliefs about oneself and the world and their ability to cope with the effect of the trauma. This study aimed to provide further evidence on the association between trauma centrality, posttraumatic stress, and psychiatric comorbidity, and examine whether cognitive distortions and trauma-coping self-efficacy would mediate the impact of trauma centrality on distress among Syrian refugees residing in Sweden. Four-hundred seventy-five Syrian refugees completed a demographic page, the Harvard Trauma Questionnaire, General Health Questionnaire-28, Centrality of Event Scale, Cognitive Distortion Scales, and trauma-coping self-efficacy. Results showed that trauma centrality was significantly correlated with posttraumatic stress disorder (PTSD) and psychiatric comorbidity after adjusting the effects of trauma exposure characteristics. Cognitive distortions mediated the impact of trauma centrality on the two distress outcomes; trauma-coping self-efficacy did not but was negatively correlated with outcomes. To conclude, the war in Syria changed self-perception, outlook on life, and identity among Syrian refugees. These changes were related to increased psychological symptoms especially for those who had distorted beliefs about themselves and the world. Refugees' belief in the lack of ability to cope with the effect of the trauma impacted psychological distress independently of changes in self-perception.
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15
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Nguyen TP, Guajardo MGU, Sahle BW, Renzaho AMN, Slewa-Younan S. Prevalence of common mental disorders in adult Syrian refugees resettled in high income Western countries: a systematic review and meta-analysis. BMC Psychiatry 2022; 22:15. [PMID: 34986827 PMCID: PMC8729124 DOI: 10.1186/s12888-021-03664-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/16/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The immense social upheaval and ongoing humanitarian crisis created by the 2011 war in Syria has forced millions of civilians to flee their homeland, many of whom seek refugee status in Western nations. Whilst it is known that the prevalence of mental illness is higher within refugee populations, this systematic review and meta-analysis aims to pool the prevalence rates of common mental disorders (namely posttraumatic stress disorder, depression and generalized anxiety disorder) in adult Syrian refugees resettled in high income Western countries. METHODS Seven electronic databases (Medline, PsychInfo, CINAHL, PTSDpubs, SCOPUS, PubMed and Embase) were searched up to the 31st of December 2020. Using pre-determined inclusion and exclusion criteria, relevant articles were screened by title and abstract, and later by full text. A meta-analysis was used to estimate the prevalence rates for each mental illness. RESULTS Eleven studies met the eligibility criteria for the systematic review. Nine of these studies had a low-moderate risk of bias and were included in the meta-analysis. Of the 4873 refugees included in the meta-analysis, the total pooled prevalence rate of having any of the three mental disorders was 33% (CI 95%, 27-40%), 40% for anxiety (CI 95%, 31-50%), 31% for depression (CI 95%, 20-44%) and 31% for PTSD (CI 95%, 22-41%). A meta-regression revealed that the total pooled prevalence rate for having any of the three mental disorders was not influenced by age, host country, duration in host country, educational or marital status. CONCLUSIONS Despite significant study heterogeneity, the prevalence rates of common mental disorders in adult Syrian refugees resettled in high-income Western countries are significantly higher than reported rates in the general population.
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Affiliation(s)
- Thomas P Nguyen
- Mental Health, School of Medicine, Western Sydney University, Sydney, Australia
| | | | - Berhe W Sahle
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research (QPS), Alfred Health Partnership, Melbourne, Victoria, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Andre M N Renzaho
- Mental Health, School of Medicine, Western Sydney University, Sydney, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Shameran Slewa-Younan
- Mental Health, School of Medicine, Western Sydney University, Sydney, Australia.
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
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16
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Stein J, Niemeyer H, Meyer C, Wirz C, Eiling A, Gruzman R, Heeke C, Stammel N, Knaevelsrud C. Posttraumatic stress in adult civilians exposed to violent conflict, war and associated human rights abuses in the Eastern Mediterranean Region: A systematic review and meta-analysis. J Affect Disord 2021; 294:605-627. [PMID: 34332362 DOI: 10.1016/j.jad.2021.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/07/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Eastern Mediterranean Region (EMR) is the stage of the world's most violent conflicts and the origin of the largest refugee population worldwide. These conflicts can result in symptoms of posttraumatic stress (PTS). To date, no comprehensive meta-analysis on proportions of PTS in civilians from the EMR has been conducted. Sample characteristics, methodological, conflict-related and displacement-related factors might affect rates of PTS. METHODS A systematic literature search for studies investigating PTS in adult civilians from the EMR was conducted until March 2020 and resulted in 118 individual study samples that were suitable for inclusion. A quality assessment was conducted. A random effects meta-analysis on proportions and sensitivity analyses were performed, and a 95% prediction interval was calculated. Subgroup analyses to identify moderators (e.g. diagnostic instruments, displacement) were conducted. RESULTS The quality of the included study samples varied. The pooled estimate of proportions from all 118 study samples was 0.31 (95% CI: 0.27 - 0.35). Heterogeneity was considerable (Q = 10151.58, p < .0001; I2 = 98.64%). The prediction interval was 0.01 to 0.76. The results remained unchanged after excluding nine outlier study samples. Heterogeneity remained high in all subgroups (range of I2: 87.91 to 99.62). LIMITATIONS Due to heterogeneity the pooled estimate cannot be interpreted. Moderators contributing to heterogeneity could not be detected. CONCLUSIONS The proportion of symptoms of PTS in civilians from the EMR varies considerably. The prediction interval indicates that the true rate falls between 1% and 76%. Future studies need to identify variables that affect heterogeneity.
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Affiliation(s)
- Jana Stein
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany; Center ÜBERLEBEN, Berlin, Germany.
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Caroline Meyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Christina Wirz
- Division of Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | | | - Rebecca Gruzman
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Carina Heeke
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Nadine Stammel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany; Center ÜBERLEBEN, Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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17
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Paudyal P, Tattan M, Cooper MJF. Qualitative study on mental health and well-being of Syrian refugees and their coping mechanisms towards integration in the UK. BMJ Open 2021; 11:e046065. [PMID: 34417211 PMCID: PMC8381320 DOI: 10.1136/bmjopen-2020-046065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aimed to explore the mental well-being of Syrian refugees and identify their coping mechanisms and pathways towards integration into new communities. DESIGN Qualitative study using in-depth semi-structured interviews. SETTING AND PARTICIPANTS Adult Syrian refugees (>18 years old) currently residing in South East of England. RESULTS 12 participants (3 women and 9 men) took part in the study, all were born in Syria and the majority (n=9) were over 45 years of age. Our findings show that Syrian refugees face constant challenges as they try to integrate into a new society. Loss of and separation from loved ones as well as the nostalgia for the homeland were often cited as a source of psychological distress that created an overwhelming sense of sadness. Participants reported that they struggled for connectedness due to cultural difference and the problematic nature of rapidly formed migrant communities in their new setting. They believed in 'being their own doctor' and turning to faith, ritual and nature for healing and comfort. Taboo and stigma around mental health and language barriers were cited as barriers to accessing mental healthcare services. CONCLUSION Past experiences and present challenges frame Syrian refugees' sense of well-being, impact use of healthcare and risk future mental health problems. It is hoped that this study will act as a catalyst for further research on this vulnerable group to promote integration, community support and culturally sensitive mental health services.
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Affiliation(s)
- Priyamvada Paudyal
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Mais Tattan
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Maxwell J F Cooper
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
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18
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Karadag O, Kilic C, Kaya E, Uner S. Challenges and lessons learned in mental health research among refugees: a community-based study in Turkey. BMC Public Health 2021; 21:1537. [PMID: 34380444 PMCID: PMC8359017 DOI: 10.1186/s12889-021-11571-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 07/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Turkey hosts nearly four million refugees and 99% live in urban areas. Research in urban settings pose different challenges and opportunities than research in refugee camps. In this article, we aimed to share the challenges and experiences we encountered in a mixed-methods study to assess mental health problems and barriers to accessing mental health care among refugees in urban areas of Turkey. DISCUSSION In our case, the main challenges in conducting research with refugees were collecting data from a highly traumatized population, difficulties with contacting undocumented asylum seekers including trust issues and the fear of deportation, the risk of secondary traumatization among data collectors, and the bureaucracy during study approval processes. Targeting a representative sample was not feasible, because of the lack of publicly available demographic data on a district level, presence of undocumented asylum seekers and high mobility among the refugees. Although respondents with significant psychological symptoms were routinely referred to available mental health services, we were able to do less for unregistered refugees with problems in accessing health care. Language/alphabet differences and differing dialects of Arabic posed another challenge in both translation and administration of the scales. Based on cultural characteristics, a gender-balanced team was used and the interviewers were gender-matched whenever needed. Also, the research team had to work after work hours and during weekends to be able to interview male refugees, since most refugee men were at work during working hours and most days of the week. CONCLUSIONS The research team's experience showed that refugee population characteristics including level of trauma, language, culture, gender, legal status, and urban setting characteristics including places of living, mobility, availability of publicly available demographic data, and outreach-related barriers lead to different challenges and ethical responsibilities of researchers and affect the research costs in terms of time, human resources and finance. Even in a host country with geographical, religious and cultural proximity to the refugees, profound challenges exist in conducting mental health research in urban settings. Learning from previous experience and collaborating with local researchers and institutions are vital for better public health research and practice outcomes.
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Affiliation(s)
- Ozge Karadag
- Center for Sustainable Development, Earth Institute, Columbia University, NY, New York, USA. .,STAR (Stress Assessment and Research Center), Hacettepe University, Ankara, Turkey.
| | - Cengiz Kilic
- STAR (Stress Assessment and Research Center), Hacettepe University, Ankara, Turkey.,Department of Psychiatry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Edip Kaya
- Department of Public Health, Institute of Health Sciences, Hacettepe University, Ankara, Turkey.,Department of Disabled Care and Rehabilitation, Vocational School of Health Services, Agri Ibrahim Cecen University, Agri, Turkey
| | - Sarp Uner
- Institute of Public Health, Hacettepe University, Ankara, Turkey
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19
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Hendrickx M, Woodward A, Fuhr DC, Sondorp E, Roberts B. The burden of mental disorders and access to mental health and psychosocial support services in Syria and among Syrian refugees in neighboring countries: a systematic review. J Public Health (Oxf) 2021; 42:e299-e310. [PMID: 31686110 DOI: 10.1093/pubmed/fdz097] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/16/2019] [Accepted: 07/21/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Exposure to conflict, violence and forced displacement can increase poor mental health among affected populations. Our aim was to examine evidence on the burden of mental disorders and access to and effectiveness of mental health and psychosocial support (MHPSS) services in Syria and among Syrian refugees in neighboring countries. METHODS A systematic review was done following systematic review criteria. Twelve bibliographic databases and additional gray literature sources were searched for quantitative and qualitative studies. Descriptive analysis and quality assessment were conducted. RESULTS Twenty-eight eligible studies were identified, of which two were with conflict-affected populations within Syria. Levels of post-traumatic stress disorder ranged from 16 to 84%, depression from 11 to 49%, and anxiety disorder from 49 to 55%. Common risk factors were exposures to trauma and having a personal or family history of mental disorder. Financial and socio-cultural barriers were identified as the main obstacles to accessing MHPSS care. Evaluations of MHPSS services, albeit from predominantly nonrandomised designs, reported positive treatment outcomes. CONCLUSIONS The MHPSS burden was high, but with considerable variation between studies. There are key evidence gaps on: MHPSS burden and interventions-particularly for those living within Syria; access and barriers to care; and implementation and evaluation of MHPSS interventions.
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Affiliation(s)
- M Hendrickx
- London School of Hygiene & Tropical Medicine, London, UK
| | - A Woodward
- KIT Health, KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - D C Fuhr
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - E Sondorp
- KIT Health, KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - B Roberts
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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20
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Spaaij J, Schick M, Bryant RA, Schnyder U, Znoj H, Nickerson A, Morina N. An exploratory study of embitterment in traumatized refugees. BMC Psychol 2021; 9:96. [PMID: 34112232 PMCID: PMC8193876 DOI: 10.1186/s40359-021-00599-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Refugees and asylum seekers are frequently exposed to violence, human rights violations and unstable living conditions before, during, and after their displacement. Elevated prevalence rates of psychiatric disorders in forcibly displaced persons are well documented. However, less is known about other problems related to common refugee experiences, such as embitterment, moral injury, and diminished self-efficacy, and how they are related to trauma exposure and post-migration living difficulties. METHODS A cross-sectional sample of 71 refugees and asylum seekers in treatment were examined regarding exposure to potentially traumatic events, post-migration living difficulties, moral injury appraisals, self-efficacy, and embitterment. RESULTS Elevated levels of embitterment were reported by 68% of participants. The regression analysis revealed that greater moral injury appraisals and low levels of self-efficacy were significantly associated with higher levels of embitterment. CONCLUSION The results provide first insights into embitterment and associated factors in refugee populations. Furthermore, they highlight the significance of moral transgressions and low levels of self-efficacy emerging from displacement and traumatic experiences for the development of mental health problems in a clinical sample of refugees. The findings have implications for future research, policy development and clinical practice.
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Affiliation(s)
- Julia Spaaij
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich (USZ), University of Zurich (UZH), Culmannstrasse 8, 8091, Zurich, Switzerland.
| | - Matthis Schick
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich (USZ), University of Zurich (UZH), Culmannstrasse 8, 8091, Zurich, Switzerland
| | | | | | - Hansjörg Znoj
- Department of Psychology, University of Bern, Bern, Switzerland
| | | | - Naser Morina
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich (USZ), University of Zurich (UZH), Culmannstrasse 8, 8091, Zurich, Switzerland
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21
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Giordano F, Cipolla A, Ungar M. Tutor of Resilience: A Model for Psychosocial Care Following Experiences of Adversity. Front Psychiatry 2021; 12:559154. [PMID: 33833694 PMCID: PMC8021705 DOI: 10.3389/fpsyt.2021.559154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 03/01/2021] [Indexed: 12/16/2022] Open
Abstract
This article describes a model for training service providers to provide interventions that build resilience among individuals who have experienced adversity. The Tutor of Resilience model emphasizes two distinct dimensions to training: (1) transforming service providers' perceptions of intervention beneficiaries by highlighting their strengths and capacity for healing; and (2) flexibly building contextually and culturally specific interventions through a five-phase model of program development and implementation. Tutor of Resilience has been employed successfully with child and youth populations under stress in humanitarian settings where mental health and psychosocial support professionals are required to design and deliver interventions that enhance resilience among vulnerable children.
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Affiliation(s)
- Francesca Giordano
- Department of Psychology – Resilience Research Unit, Università Cattolica del Sacro Cuore Largo Gemelli 1, Milan, Italy
| | - Alessandra Cipolla
- Department of Psychology – Resilience Research Unit, Università Cattolica del Sacro Cuore Largo Gemelli 1, Milan, Italy
| | - Michael Ungar
- Canada Research Chair in Child, Family and Community Resilience, Resilience Research Centre Dalhousie University, Halifax, NS, Canada
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22
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Abstract
More than 21 million people globally are refugees. More than half of these (>10 million) are children, representing a highly vulnerable population. Most children experience high levels of trauma exposure, including war trauma, as well as substantial migration- and resettlement-related stress. These exposures confer risk for mental health problems, including posttraumatic stress disorder (PTSD), but their relative contributions have not been fully explicated. These effects may be modulated by the developmental timing of trauma and stress exposure: childhood trauma and stress are broadly linked to worse health outcomes across the lifespan, but the developmental specificity of these effects remains uncertain. Refugee children typically experience the trauma leading up to displacement (e.g., civil war) which often lasts for decades, and for some, followed by resettlement. Longitudinal studies that follow children through this process can provide unique insight into how these experiences of trauma, displacement, and resettlement during development impact mechanisms of risk and resilience. They can also elucidate how environmental and physiological factors may modulate the effects of trauma and stress. The present study includes two groups of families (parents and their 7- to 17-year-old children): (1) Syrian and Iraqi refugee families who experienced war-zone trauma before resettling in the United States in ~2016, and (2) Arab immigrant families who did not experience war-zone trauma prior to resettlement in the United States in ~2016. We assessed symptoms of anxiety, depression, and PTSD in refugee and immigrant children and parents. Skin conductance responses, a measure of autonomic response, saliva samples for genetic and epigenetic analyses, and information about social and environmental context, including family structure, resources, and neighborhood quality, were also collected. Refugee participants provided data at three time points spanning ~3 years following resettlement in the United States: Wave 1, within 1 month of resettlement, Wave 2, 12–24 months post resettlement, and Wave 3 planned for 24–36 months resettlement. Immigrant participants will provide data once, within 3–5 years after immigration, matching the age of Wave 1. This comparison group enables us to compare mental health and biomarkers between refugees and immigrants. Results of these comparative analyses will provide insight into the impact of war trauma versus other types of trauma and adversity on biomarkers of child mental health outcomes. Results from the longitudinal analyses will address refugee mental health trajectories over time, and, in children, across development. Initial data from Wave 1 showed high levels of anxiety in refugee children, as well as high levels of PTSD symptoms and anxiety in their parents. Together, results from these comparative and longitudinal analyses will provide insight into multiple aspects of trauma and stress exposure in refugees and immigrants, including how the developmental timing of trauma exposure impacts biomarkers and mental health across development. Our assessment of multiple factors affecting childhood mental health following trauma exposure, including familial, neighborhood and social context following resettlement may identify modifiable targets for interventions to support well-being in refugees.
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23
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Kashyap S, Keegan D, Liddell BJ, Thomson T, Nickerson A. An Interaction Model of Environmental and Psychological Factors Influencing Refugee Mental Health. J Trauma Stress 2021; 34:257-266. [PMID: 33314393 DOI: 10.1002/jts.22636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 11/09/2022]
Abstract
In this paper, we draw on empirical research and theoretical models of refugee and posttrauma mental health to propose the "Psychological Interaction with Environment (PIE) Matrix Model" of refugee mental health. This model focuses on the mental health of adult refugees and proposes that psychological factors and the external environment interact to influence mental health outcomes and functioning for individuals with refugee backgrounds. Environmental factors include adversity faced before, during, and after the migration journey, including adversity faced in a resettlement or postdisplacement environment. Psychological factors refer to psychological (i.e., cognitive and emotional) mechanisms that individuals may use to cope with adversity. We posit that individuals from refugee backgrounds are likely to show individual differences in psychological processes that may protect against or underpin the development and maintenance of psychopathology following exposure to trauma and displacement. The PIE Matrix Model proposes a framework to guide intervention by identifying key pathways by which psychological and environmental factors impact one another. We suggest that psychological interventions can be targeted according to the kind and level of support different individuals may require, based on individualized and context-driven assessments of the interaction between environmental and psychological factors at any given point in time. This model draws on existing models of refugee adaptation and highlights the need for longitudinal and experimental research to explain the interaction between these factors and their causal impact on refugee mental health.
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Affiliation(s)
- Shraddha Kashyap
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Belinda J Liddell
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia
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24
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Nissen A, Cauley P, Saboonchi F, J Andersen A, Solberg Ø. Mental health in adult refugees from Syria resettled in Norway between 2015 and 2017: a nationwide, questionnaire-based, cross-sectional prevalence study. Eur J Psychotraumatol 2021; 12:1994218. [PMID: 34900120 PMCID: PMC8654398 DOI: 10.1080/20008198.2021.1994218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The number of forcibly displaced people globally has never been higher, with refugees from Syria constituting the largest displaced population worldwide. Many studies have documented elevated levels of mental health problems in refugee populations, though prevalence estimates of common mental disorders vary considerably between studies, explained both by methodological and contextual factors. OBJECTIVE Using questionnaire-based screening checklists to approximate the prevalence of and investigate risk factors for post-traumatic stress disorder (PTSD), anxiety and depression among adult refugees from Syria resettled in Norway and to compare estimates with a sister-study in Sweden. METHOD Cross-sectional survey of a randomly selected sample from the National Population Register in Norway of adult refugees from Syria who were granted residency rights in Norway between 2015 and 2017 (Nsample = 9,990; nrespondents = 902). Above-threshold scores on the Harvard Trauma Questionnaire (HTQ) and Hopkins Symptoms Checklist (HSCL-25) defined caseness for PTSD (HTQ>2.06); anxiety (HSCLanxitey>1.75); and depression (HSCLdepression>1.80). RESULTS Weighted, checklist-positive prevalence estimates for PTSD, anxiety and depression were 29.7% (25.4%-34.4%), 30.1% (25.7%-34.9%), and 45.2% (40.6%-49.8%), respectively. Cumulative exposure to potentially traumatic experiences before or during flight was a clear risk factor for all outcomes, and female gender was a risk factor for anxiety and depression, though only in adjusted analyses. The choice of HTQ cut-off to define PTSD caseness (2.5 vs. 2.06) had a notable effect on prevalence estimates. CONCLUSION In line with prior evidence, the present study suggests adult refugees from Syria resettled in Norway have higher rates of anxiety and depression and markedly higher rates of PTSD compared to general, non-refugee populations, and that this is clearly linked to past traumatic experiences. Prevalence estimates were highly consistent with estimates from the sister-study in Sweden, which used almost identical methodology. Findings underline the importance of screening for and intervening on mental health problems in newly arrived refugees.
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Affiliation(s)
- Alexander Nissen
- Division for Forced Migration and Refugee Health, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.,Department of Health Sciences, Swedish Red Cross University College, Huddinge, Sweden
| | - Prue Cauley
- Division for Forced Migration and Refugee Health, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Fredrik Saboonchi
- Department of Health Sciences, Swedish Red Cross University College, Huddinge, Sweden.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Arnfinn J Andersen
- Division for Forced Migration and Refugee Health, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Øivind Solberg
- Division for Forced Migration and Refugee Health, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.,Department of Health Sciences, Swedish Red Cross University College, Huddinge, Sweden
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25
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The role of emotion regulation as a mediator between early life stress and posttraumatic stress disorder, depression and anxiety in Syrian refugees. Transl Psychiatry 2020; 10:371. [PMID: 33139699 PMCID: PMC7606478 DOI: 10.1038/s41398-020-01062-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 06/11/2020] [Accepted: 07/03/2020] [Indexed: 11/29/2022] Open
Abstract
Early life stress is an important factor in later psychopathology, including symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety. The purpose of the present study was to investigate the effect of early life stress on psychiatric symptoms within a sample of Syrian refugees. In this model, the use of cognitive emotion regulation strategies was assessed as a potential mediator of the relationship between early life stress and current symptoms of PTSD, depression, and anxiety. Bootstrap analyses were generated to test the indirect effect of emotion regulation (Cognitive Emotion Regulation Questionnaire) on the relationship between early life stress (Childhood Trauma Questionnaire), PTSD (Harvard Trauma Questionnaire), depressive (PHQ-9) and anxiety (GAD-7) symptoms in eighty-nine Syrian refugees resided in Germany (n = 49) and Jordan (n = 40). The indirect effect of maladaptive strategies was significant between early life stress and psychopathology, whereas the mediation effect of adaptive strategies was not significant. The findings provide an evidence that emotional dysregulation is an underlying factor affecting psychological symptoms in refugees with adverse childhood experiences. These results suggest targeting cognitive emotion regulation in prospective prevention and treatment strategies.
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26
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Berthold SM, Mollica RF, Silove D, Tay AK, Lavelle J, Lindert J. The HTQ-5: revision of the Harvard Trauma Questionnaire for measuring torture, trauma and DSM-5 PTSD symptoms in refugee populations. Eur J Public Health 2020; 29:468-474. [PMID: 30561573 DOI: 10.1093/eurpub/cky256] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Harvard Trauma Questionnaire (HTQ) was developed 25 years ago as a cross-cultural screening instrument to document trauma exposure, head trauma and trauma-related symptoms in refugees. This article aims to: (i) outline the process of revision of Part IV of the HTQ to (a) include the new DSM-5 diagnostic criteria for PTSD, and (b) separate out and more fully develop the refugee-specific functioning items; and (ii) promote a consistent approach to the validation of the HTQ-5 when adapted for use in other cultures and language groups. METHODS Our process involved item mapping; expert consultations; generating items according to the new DSM-5 criteria; and drafting, refinement and finalization of the revised measure focusing closely on issues of meaning, future translation into multiple languages and comprehension amongst groups with low literacy and little or no exposure to Western trauma concepts. Validity and reliability testing of the new HTQ-5 is underway. RESULTS The HTQ symptom checklist was modified consistent with current DSM-5 diagnostic criteria to identify those refugees at risk for mental health and other symptoms associated with traumatic life events, disability and dysfunction. CONCLUSIONS Accurate screening of post-traumatic distress and dysfunction enables those working with refugees to triage them more effectively to scarce health and mental health resources. When developing screening measures to inform public health policy and practice, it is vital that these measures can bridge the gap between western (etic) nosologies and indigenous (emic) understandings of traumatic stress.
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Affiliation(s)
- S Megan Berthold
- School of Social Work, University of Connecticut, Hartford, CT, USA
| | - Richard F Mollica
- Harvard Program in Refugee Trauma, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia
| | - Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia
| | - James Lavelle
- Harvard Program in Refugee Trauma, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Jutta Lindert
- Department of Health and Social Work, University of Applied Sciences Emden, Emden, Germany; Women's Research Center, Brandeis University, Waltham, MA, United States
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Chung MC, AlQarni N, AlMazrouei M, Al Muhairi S, Shakra M, Mitchell B, Al Mazrouei S, Al Hashimi S. Posttraumatic stress disorder and psychiatric co-morbidity among Syrian refugees: the role of trauma exposure, trauma centrality, self-efficacy and emotional suppression. J Ment Health 2020; 30:681-689. [PMID: 32325003 DOI: 10.1080/09638237.2020.1755023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: The devastation of the Syrian war can lead to a drastic re-evaluation of oneself and alteration in self-capacities. Yet, little is known regarding its impact on these domains among Syrian refugees.Aims: To investigate the inter-relationship between trauma characteristics, trauma centrality, self-efficacy, emotional suppression, PTSD and psychiatric co-morbidity among Syrian refugees.Methods: 1197 refugees from Turkey and Sweden completed the Harvard Trauma Questionnaire, General Health Questionnaire-28, Centrality of Event Scale, Generalized Self-Efficacy Scale and Courtauld Emotional Control Scale.Results: Using the DSM-IV criteria for PTSD from the Harvard Trauma Questionnaire, 43% met the criteria. The PTSD group reported significantly higher levels of trauma characteristics, trauma centrality and psychiatric co-morbidity but a lower level of self-efficacy than the non-PTSD group. Trauma characteristics were positively associated with trauma centrality; trauma centrality was negatively correlated with self-efficacy. Contrary to hypothesis, self-efficacy was positively correlated with emotional suppression which was positively correlated with psychiatric co-morbidity but not PTSD.Conclusions: The experience of war can lead to the emergence of PTSD among Syrian refugees. Exposure to war can alter self-perception, belief of personal mastery over one's future and the way emotion is expressed, all of which can have specific effects on general psychological symptoms.
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Affiliation(s)
- Man Cheung Chung
- Department of Educational Psychology, Ho Tim Building, Faculty of Education, the Chinese University of Hong Kong, Shatin NT, Hong Kong
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28
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Wang N, Chung MC, Wang Y. The relationship between posttraumatic stress disorder, trauma centrality, posttraumatic growth and psychiatric co-morbidity among Chinese adolescents. Asian J Psychiatr 2020; 49:101940. [PMID: 32065961 DOI: 10.1016/j.ajp.2020.101940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/09/2020] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Abstract
This study examined the inter-relationship between posttraumatic stress disorder (PTSD) from past trauma, psychiatric co-morbidity, trauma centrality and posttraumatic growth (PTG) among Chinese adolescents. Nine hundred and forty-eight Chinese adolescents (M = 462, F = 486) were recruited from two secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Centrality of Events Scale, the Posttraumatic Growth Inventory, the General Health Questionnaire-28, and the Educational Stress Scale for Adolescents. After controlling for demographic variables and levels of academic stress, structural equation modeling showed that PTSD was positively associated with trauma centrality and psychiatric co-morbidity but negatively associated with posttraumatic growth. Trauma centrality mediated the impacts of PTSD on posttraumatic growth and psychiatric co-morbidity. To conclude, PTSD from past trauma could impact adolescents' ways of perceiving positive aspects of their trauma and psychological well-being. Such impact, however, was influenced by the changes in their self-concept.
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Affiliation(s)
- Na Wang
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong.
| | - Man Cheung Chung
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong.
| | - Yabing Wang
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong.
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29
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Peconga EK, Høgh Thøgersen M. Post-traumatic stress disorder, depression, and anxiety in adult Syrian refugees: What do we know? Scand J Public Health 2019; 48:677-687. [PMID: 31814514 DOI: 10.1177/1403494819882137] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The crisis in Syria has resulted in vast numbers of refugees seeking asylum in Syria's neighboring countries and Europe. Refugees are at considerable risk of developing common mental disorders, including depression, anxiety, and post-traumatic stress disorder. Since the war, no systematic review has been conducted regarding the prevalence of these in the Syrian refugee group. Research is needed to develop strategies to improve the integration of Syrian refugees. OBJECTIVE This study provides a systematic review of peer-reviewed articles that feature originally collected data regarding the prevalence of post-traumatic stress, depression, and anxiety in adult Syrian refugees. METHODS The authors searched online databases (PsychInfo, PubMed, PILOTS) for peer-reviewed articles that used validated screening tools to provide mental health prevalence rate estimates in adult Syrian refugees. This article explores potential sources of heterogeneity, including individual risk factors such as demographic and environmental variables. RESULTS In total, 15 eligible studies provided cross-sectional data for 8176 adult Syrian refugees resettled in 10 countries, with significant variation in assessment and sampling methods. Combined, these studies indicate prevalence rates of 43.0% (range: 23.4-83.4%) for post-traumatic stress, 40.9% (range: 20-44.1%) for depression, and 26.6% (range: 19.30-31.8%) for anxiety morbidity in adult Syrian refugees. Larger and more rigorous surveys reported similar prevalence rates to studies with less rigorous designs, but vast heterogeneity in prevalence of morbidity persisted among all. Conclusions: Syrian refugees could be over 10 times more likely to develop post-traumatic stress and other disorders than the general population. Although there are limitations when comparing studies with different research methodologies, the results of this study suggest increased focus on adequate mental health support is necessary.
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Affiliation(s)
- Emma K Peconga
- Department of Psychology, University of Washington, USA.,Department of Rehabilitation, The Danish Institute Against Torture (Dignity), Denmark
| | - Marie Høgh Thøgersen
- Department of Rehabilitation, The Danish Institute Against Torture (Dignity), Denmark
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30
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Posttraumatic Stress and Depression Among Syrian Refugees Living in Turkey: Findings From an Urban Sample. J Nerv Ment Dis 2019; 207:995-1000. [PMID: 31658240 DOI: 10.1097/nmd.0000000000001104] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although most of the 3.6 million Syrian refugees in Turkey live outside refugee camps, most mental health research is on camp residents and few are on those living in cities. We aimed to assess the prevalence and predictors of posttraumatic stress disorder (PTSD) and depression in Syrian refugees living in an urban area in Turkey. A total of 420 adult Syrians living in Ankara were assessed using the Harvard Trauma Questionnaire and the Beck Depression Inventory. Probable PTSD and depression rates were 36.5% and 47.7%, respectively. Female sex, physical illness, and greater number of potentially traumatic events predicted both PTSD and depression. PTSD was additionally predicted by past psychiatric illness, and depression was predicted by lower economic status. Interestingly, lower economic status predicted depression among men, but not among women. Studies on refugees should be sensitive to factors that could have a significant effect on mental health such as sex or residence.
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31
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Gallagher MW, Long LJ, Phillips CA. Hope, optimism, self‐efficacy, and posttraumatic stress disorder: A meta‐analytic review of the protective effects of positive expectancies. J Clin Psychol 2019; 76:329-355. [DOI: 10.1002/jclp.22882] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Matthew W. Gallagher
- Department of Psychology, Texas Institute for Measurement, Evaluation, and StatisticsUniversity of HoustonHouston Texas
| | - Laura J. Long
- Department of Psychology, Texas Institute for Measurement, Evaluation, and StatisticsUniversity of HoustonHouston Texas
| | - Colleen A. Phillips
- Department of Psychology, Texas Institute for Measurement, Evaluation, and StatisticsUniversity of HoustonHouston Texas
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Sengoelge M, Johnson-Singh CM, Mittendorfer-Rutz E, Vaez M, Saboonchi F. Identifying subgroups of refugees from Syria resettled in Sweden based on multiple trauma exposures: A latent class analysis of trauma history and mental health outcomes. J Psychosom Res 2019; 125:109814. [PMID: 31470254 DOI: 10.1016/j.jpsychores.2019.109814] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/01/2019] [Accepted: 08/14/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Many refugees have been subjected to pre-migratory trauma. Evidence is needed to address the heterogeneity within refugee populations in regard to patterns of multiple trauma exposures. This study identified subgroups within a refugee population displaying different profiles of multiple trauma exposures and assessed sociodemographic predictors and differences in mental health symptom severity across these classes. METHODS Study population consisted of 1215 refugees from Syria resettled in Sweden. Latent class analysis 3-step method for modelling predictors and outcomes and a class-specific weighted multigroup approach were used to identify classes of refugees using self-reported data on violent and non-violent trauma exposures, sociodemographic variables and symptom severity scores for depression, anxiety and PTSD. RESULTS Three classes were identified: class 1 'multiple violent and non-violent trauma' (39.3%, n = 546); class 2 'witnessing violence and multiple non-violent trauma' (40.8%, n = 569); and class 3 'low multiple non-violent trauma' (20.1%, n = 281). Trauma exposure and gender significantly predicted class membership. Male gender and highest severity of mental ill health defined class 1. Female gender predicted higher mental ill health within classes 1 and 2. Across all three classes living with a partner was associated with lower severity of mental ill health regardless of trauma exposure classes. CONCLUSIONS There are distinct patterns within refugee populations concerning exposure to multiple trauma. Violence is a primary marker for higher likelihood of multiple trauma exposures and severity of mental health. Gender predisposes individuals to trauma exposure and its outcomes differentially.
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Affiliation(s)
- Mathilde Sengoelge
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden.
| | - Charisse M Johnson-Singh
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Saboonchi
- Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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33
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Veronese G, Pepe A, Sala G, Yamien I, Vigliaroni M. Positive experience, psychological functioning, and hope for the future as factors associated with mental health among young Sub-Saharan internally displaced people (IDP): A quantitative pilot study. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2019. [DOI: 10.1080/00207411.2019.1635849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Guido Veronese
- Human Sciences, University of Milano-Bicocca, Milan, Italy
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34
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El Arnaout N, Rutherford S, Zreik T, Nabulsi D, Yassin N, Saleh S. Assessment of the health needs of Syrian refugees in Lebanon and Syria's neighboring countries. Confl Health 2019; 13:31. [PMID: 31297141 PMCID: PMC6598365 DOI: 10.1186/s13031-019-0211-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background Health needs of displaced Syrians in refugee hosting countries have become increasingly complex in light of the protracted Syrian conflict. The primary aim of this study was to identify the primary health needs of displaced Syrians in Iraq, Jordan, Lebanon, Turkey, and Syria. Methods A systematic review was performed using 6 electronic databases, and multiple grey literature sources. Title, abstract, and full text screening were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The target population was Syrian individuals displaced due to conflict in Syria and its neighboring countries. The outcomes of interest were health needs (i.e. health problems that can be addressed by health services), gaps in health services, training, and workforce. Studies on mixed refugee populations and Syrians displaced prior to the conflict were excluded. Results The Lebanon-specific results of the review were validated through two stakeholder roundtable discussions conducted with representatives from primary healthcare centers, non-governmental organizations and humanitarian aid agencies. A total of 63 articles were included in the analysis. Mental health and women's health were identified as the greatest health needs in the region. The most common health problems were Non-communicable diseases in Jordan, women's health in Lebanon and mental health in Turkey. Studies addressing gaps in services found the highest gap in general healthcare services, followed by women's health, mental health, and vaccinations. Sub-optimal training and availability of health workers was also noted particularly in Syria.Results from the stakeholders' discussions in Lebanon showed communicable diseases, women's health and mental health as the main health needs of Syrian refugees in Lebanon. Reported barriers to accessing health services included geographical barriers and lack of necessary awareness and education. Conclusion There is a need for an enhanced synchronized approach in Syria's refugee hosting neighboring countries to reduce the existing gaps in responding to the needs of Syrian refugees, especially in regards to women's health, mental health, and communicable diseases. This mainly includes training of healthcare workers to ensure a skilled workforce and community-based efforts to overcome barriers to access, including lack of knowledge and awareness about highly prevalent health conditions.
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Affiliation(s)
- Nour El Arnaout
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Spencer Rutherford
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Thurayya Zreik
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Dana Nabulsi
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Nasser Yassin
- 2Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon.,3Issam Fares Institute for Public Policy and International Affairs, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Shadi Saleh
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon.,2Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
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Triberti S, Gorini A, Savioni L, Sebri V, Pravettoni G. Avatars and the Disease: Digital Customization as a Resource for Self-Perception Assessment in Breast Cancer Patients. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2019; 22:558-564. [PMID: 31194583 DOI: 10.1089/cyber.2018.0461] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Avatars, or users' renditions within digital environments, may change depending on modifications of users' self-conception. According to literature, chronic health conditions influence patients and survivors' identity, because living with a disease requires people to reconfigure their self-representation and their own daily life and future plans. This is especially true for breast cancer, whose treatment and surgery also affect patients' body image, sexual identity, and sense of womanhood. In this study, 22 breast cancer survivors were asked to create multiple avatars resembling their actual self (AS), their ideal self (IS), and their self connected to the disease experience; then, they were asked to rate their attitudes toward their three avatars. Results show that disease avatars are significantly different in patients' attitudes toward them from AS and IS avatars. In addition, attitudes toward one's own avatars appeared partially related to clinically relevant psychological states, such as anxiety and depression. Discussion explores suggestions for usage of avatars in interventions for assessment and quality-of-life promotion among chronic patients.
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Affiliation(s)
- Stefano Triberti
- 1Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,2Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Alessandra Gorini
- 1Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,2Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Lucrezia Savioni
- 1Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,2Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Sebri
- 1Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,2Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- 1Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,2Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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36
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Chung MC, AlQarni N, AlMazrouei M, Al Muhairi S, Shakra M, Mitchell B, Al Mazrouei S, Al Hashimi S. Posttraumatic Stress Disorder and Psychiatric Co-morbidity among Syrian Refugees of Different Ages: the Role of Trauma Centrality. Psychiatr Q 2018; 89:909-921. [PMID: 29981008 DOI: 10.1007/s11126-018-9586-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
It has been documented that trauma centrality is associated with posttraumatic stress disorder (PTSD) and psychiatric co-morbidity among Syrian refugees. Whether age would influence the levels of the above constructs and the association between trauma centrality and distress outcomes is unclear. This study compared age differences in 1) the levels of trauma centrality, posttraumatic stress disorder and psychiatric co-morbidity, and 2) models depicting the association between trauma centrality and distress outcomes among Syrian refugees. One thousand one hundred and ninety-seven refugees completed the Centrality of Event Scale, Harvard Trauma Questionnaire and General Health Questionnaire-28. Age groups were divided into young, middle-aged adults and adults of 45 or above. No significant group differences were found in the proportion of refugees meeting the diagnostic criteria for PTSD. Controlling for demographic variables, all subscales of trauma centrality and psychiatric co-morbidity were significantly different between groups. Young adults reported significantly less trauma centrality and psychiatric co-morbidity than the other groups. Multiple-indicator multiple-cause modelling showed that trauma centrality was significantly correlated with PTSD and psychiatric co-morbidity. Multi-group analysis showed the model for the young adult group to be significantly different from the middle-aged group model. To conclude, age did not seem to influence the severity of PTSD among Syrian refugees. The war had a less severe impact on young adults' sense of self and other psychological problems than those who were older. The way in which young and middle-aged adults responded to distress varied depending on environment and personal characteristics.
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Affiliation(s)
- Man Cheung Chung
- Department of Educational Psychology, Ho Tim Building, Faculty of Education, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
| | - Nowf AlQarni
- Zayed University, Abu Dhabi, United Arab Emirates
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Benight CC, Harwell A, Shoji K. Self-Regulation Shift Theory: A Dynamic Personal Agency Approach to Recovery Capital and Methodological Suggestions. Front Psychol 2018; 9:1738. [PMID: 30298033 PMCID: PMC6160534 DOI: 10.3389/fpsyg.2018.01738] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/28/2018] [Indexed: 11/13/2022] Open
Abstract
Recovery capital highlights person and environmental resources associated with overcoming significant life challenges. This paper utilizes social cognitive theory as a framework for understanding how recovery capital functions in trauma adaptation. This theory outlines the bidirectional, dynamic interactions among person (e.g., cognitive and affective), behavioral (e.g., problem focused coping), and environmental variables (i.e., triadic reciprocal determinism). The value of this approach to understanding human adaptation to trauma is that it targets the self-regulatory processes that unfold for trauma survivors as they attempt to put their lives back together. Self-regulation shift theory (SRST), as an extension to social cognitive theory, is offered to explain how self-regulation is involved in both positive and negative adjustment. The theory uses a dynamical systems approach and highlights the mechanisms related to non-linear shifts in both positive and negative trauma recovery. According to SRST, trauma recovery may not be linear with threshold shifts (i.e., bifurcations) from one organized state (broken self) to another (empowered self). Coping self-efficacy perceptions are a critical factor influencing these threshold shifts. This paper concludes with a brief review of study designs and analytic procedures that can facilitate the application of non-linear dynamic research in this area.
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Affiliation(s)
- Charles C Benight
- Department of Psychology, University of Colorado, Colorado Springs, Colorado Springs, CO, United States.,Trauma, Health, and Hazards Center, University of Colorado, Colorado Springs, Colorado Springs, CO, United States
| | - Aaron Harwell
- Department of Psychology, University of Colorado, Colorado Springs, Colorado Springs, CO, United States
| | - Kotaro Shoji
- Trauma, Health, and Hazards Center, University of Colorado, Colorado Springs, Colorado Springs, CO, United States
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Prevalence of Possible Mental Disorders in Syrian Refugees Resettling in the United States Screened at Primary Care. J Immigr Minor Health 2018; 21:664-667. [DOI: 10.1007/s10903-018-0797-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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39
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Vermeulen M, Brown AD, Raes F, Krans J. Decreasing Event Centrality in Undergraduates Using Cognitive Bias Modification of Appraisals. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9936-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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40
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Cheung Chung M, AlQarni N, AlMazrouei M, Al Muhairi S, Shakra M, Mitchell B, Al Mazrouei S, Al Hashimi S. The impact of trauma exposure characteristics on post-traumatic stress disorder and psychiatric co-morbidity among Syrian refugees. Psychiatry Res 2018; 259:310-315. [PMID: 29100134 DOI: 10.1016/j.psychres.2017.10.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 10/10/2017] [Accepted: 10/22/2017] [Indexed: 10/18/2022]
Abstract
This study investigated the impact of trauma exposure characteristics on post-traumatic stress disorder (PTSD) and psychiatric co-morbidity among Syrian refugees. One thousand one hundred and ninety-seven refugees residing in Turkey and Sweden participated in the research. They completed the Harvard Trauma Questionnaire and the General Health Questionnaire-28. Forty-three percent of refugees met the cutoff for PTSD. After adjusting for location of residence, witnessing horror and exposure to life threat and assault were significantly correlated with PTSD and psychiatric co-morbidity respectively. Death of, or life threat to family members or friends were significantly correlated with both distress outcomes. Refugees residing in Turkey had significantly higher levels of PTSD, psychiatric co-morbidity and trauma characteristics than those living in Sweden. To conclude, Syrian refugees who witnessed horror, life threat or had family or friends die, tended to have elevated psychological distress. Levels of distress among resettled refugees can vary depending on country of resettlement. We recommend systematic mental health screening and implementation of psychotherapeutic interventions to address issues pertaining to subjective experience of resettlement and trauma exposure for Syrian refugees.
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Affiliation(s)
- Man Cheung Chung
- The Chinese University of Hong Kong, Department of Educational Psychology, Ho Tim Building, Faculty of Education, Shatin NT, Hong Kong.
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