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Niner S. Gender relations and the establishment of the LGBT movement in Timor-Leste. WOMENS STUDIES INTERNATIONAL FORUM 2022. [DOI: 10.1016/j.wsif.2022.102613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kaur G, Weinberg R, Milewski AR, Huynh S, Mauer E, Hemmings HC, Pryor KO. Chronic pain diagnosis in refugee torture survivors: A prospective, blinded diagnostic accuracy study. PLoS Med 2020; 17:e1003108. [PMID: 32502219 PMCID: PMC7274371 DOI: 10.1371/journal.pmed.1003108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/04/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND An estimated 87% of torture survivors experience chronic pain such as brachial plexopathy from upper extremity suspension or lumbosacral plexus injury from leg hyperextension. However, a vast majority of pain is undetected by evaluators due to a lack of diagnostic tools and confounding psychiatric illness. This diagnostic gap results in exclusive psychological treatment rather than multimodal therapies, substantially limiting rehabilitation. We hypothesized that the United Nations Istanbul Protocol (UNIP) would have a sensitivity of approximately 15% for pain detection, and that the use of a validated pain screen would improve its sensitivity by at least 29%, as compared to the reference standard (pain specialist evaluation). METHODS AND FINDINGS This prospective blind-comparison-to-gold-standard study of survivors of torture, as defined by the World Medical Association, took place at Weill Cornell Medicine between February 1, 2017, and June 21, 2019. 11 women and 9 men, for a total of 20 participants, were included in the analysis. Five participants received 2 UNIP evaluations, for a total of 25 unique evaluations included in the analysis. Participants were representative of a global population, with home countries in Africa, Central America, South Asia, the Caribbean, and the Middle East. Methods of torture experienced were homogeneous, following the predictable pattern of systematic torture. Participants first received the standard evaluation protocol for torture survivors (UNIP) by a trained evaluator, and subsequently received a validated pain screen (Brief Pain Inventory-Short Form [BPISF]) followed by a noninvasive examination by a pain specialist physician (reference standard). The primary outcome was the diagnostic and treatment capability of the standard protocol (index test) versus the validated pain screen (BPISF), as compared to the reference standard. Trained evaluators performing the initial assessment with the UNIP (index test) were blinded to the study, and the pain specialist physician (reference standard) was blinded to the outcome of the initial UNIP evaluation and the BPISF; data from the initial UNIP assessment were not gathered by the principal investigator until all other study procedures were completed. Providers using only the UNIP captured pain in a maximum of 16% of evaluations, as compared to 85% of participants being diagnosed with pain by the reference standard. When employed, the validated pain screen had a sensitivity of 100% (95% CI 72%-100%) and a negative predictive value of 100%, as compared to a sensitivity of 24% (95% CI 8%-50%) and a negative predictive value of 19% (95% CI 5%-46%) for the index test. The difference in the sensitivity of the UNIP as compared to the BPISF was significant, with p < 0.001. No adverse events owing to participation in the study were reported by participants. Limitations of the study include small sample size, its single-site nature, and the exclusion of individuals who did not speak 1 of the 5 study languages. CONCLUSIONS These data indicate that a validated pain screen can supplement the current global standard assessment of torture survivors, the UNIP, to increase the accuracy of pain diagnosis. TRIAL REGISTRATION ClinicalTrials.gov NCT03018782.
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Affiliation(s)
- Gunisha Kaur
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, United States of America
- * E-mail:
| | - Roniel Weinberg
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, United States of America
| | - Andrew Robert Milewski
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, United States of America
| | - Samantha Huynh
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, United States of America
| | - Elizabeth Mauer
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, United States of America
| | - Hugh Carroll Hemmings
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, United States of America
| | - Kane Owen Pryor
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, United States of America
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Niner S. Veterans and Heroes: The Militarised Male Elite in Timor-Leste. THE ASIA PACIFIC JOURNAL OF ANTHROPOLOGY 2020. [DOI: 10.1080/14442213.2019.1711152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tay AK, Rees S, Tam N, Kareth M, Silove D. Developing a measure of adaptive stress arising from the psychosocial disruptions experienced by refugees based on a sample of displaced persons from West Papua. Int J Methods Psychiatr Res 2019; 28:e1770. [PMID: 30740811 PMCID: PMC6877204 DOI: 10.1002/mpr.1770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/23/2018] [Accepted: 12/01/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES We report the testing and refinement of the Adaptive Stress Index (ASI), a psychosocial assessment tool designed to measure the longer terms stressors of adapting to the psychosocial disruptions experienced by refugees. METHODS The ASI is based on a theoretical model, the Adaptation and Development After Persecution and Trauma (ADAPT), which postulates that five psychosocial domains are disrupted by conflict and displacement, namely, safety and security, attachment, access to justice, roles and identities, and existential meaning. We used confirmatory factor analysis (CFA) and item response theory (IRT) to shorten and refine the measure based on data obtained from 487 refugees participating in a household survey in Papua New Guinea (response rate: 85.8%). RESULTS CFA allowed the exclusion of low loading items (<0.5) and locally dependent items. A good fit was found for single models representing each of the five ASI domains. A graded response IRT model identified items with the highest discrimination and information content in each of the five derived scales. CONCLUSIONS The analysis produced a shortened and refined ASI for use amongst refugee populations. The study offers a guide to adapting measures of stress for application to diverse populations exposed to mass conflict and refugee displacement.
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Affiliation(s)
- Alvin Kuowei Tay
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Rees
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Natalino Tam
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Moses Kareth
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Derrick Silove
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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NINER SARA, LAY JOTHAM, WARREN NARELLE, O'CONNELL MICHAEL, EDGINGTON-MITCHELL DANIEL. How development happens: Safe and sustainable energy, community development projects, and implementation challenges in Timor-Leste. ANNALS OF ANTHROPOLOGICAL PRACTICE 2018. [DOI: 10.1111/napa.12121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- SARA NINER
- School of Social Sciences, Monash University
| | - JOTHAM LAY
- Faculty of Engineering, Monash University
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The role of grief symptoms and a sense of injustice in the pathways to post-traumatic stress symptoms in post-conflict Timor-Leste. Epidemiol Psychiatr Sci 2017; 26:403-413. [PMID: 27573421 PMCID: PMC6998498 DOI: 10.1017/s2045796016000317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS Grief symptoms and a sense of injustice may be interrelated responses amongst persons exposed to mass conflict and both reactions may contribute to post-traumatic stress disorder (PTSD) symptoms. As yet, however, there is a dearth of data examining these relationships. Our study examined the contributions of grief and a sense of injustice to a model of PTSD symptoms that included the established determinants of trauma events, ongoing adversity and severe psychological distress. The study involved a large population sample (n = 2964, response rate: 82.4%) surveyed in post-conflict Timor-Leste. METHODS The survey sites included an urban administrative area (suco) in Dili, the capital of Timor-Leste and a rural village located an hour's drive away. Culturally adapted measures were applied to assess conflict related traumatic events (TEs), ongoing adversity, persisting preoccupations with injustice, symptoms of grief, psychological distress (including depressive symptoms) and PTSD symptoms. RESULTS We tested a series of structural equation models, the final comprehensive model, which included indices of grief symptoms and injustice, producing a good fit. Locating grief symptoms as the endpoint of the model produced a non-converging model. In the final model, strong associations were evident between grief and injustice (β = 0.34, s.e. = 0.02, p < 0.01) and grief and PTSD symptoms (β = 0.14, s.e. = 0.02, p < 0.01). The sense of injustice exerted a considerable effect on PTSD symptoms (β = 0.13, s.e. = 0.03, p < 0.01). In addition, multiple indirect paths were evident, most involving grief and a sense of injustice, attesting to the complex inter-relationship of these factors in contributing to PTSD symptoms. CONCLUSIONS Our findings support an expanded model of PTSD symptoms relevant to post-conflict populations, in which grief symptoms and a sense of injustice play pivotal roles. The model supports the importance of a focus on loss, grief and a sense of injustice in conducting trauma-focused psychotherapies for PTSD amongst populations exposed to mass conflict and violence. Further research is needed to identify the precise mechanisms whereby grief symptoms and the sense of injustice impact on PTSD symptoms.
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Tay AK, Mohsin M, Rees S, Steel Z, Tam N, Soares Z, Baker J, Silove D. The factor structures and correlates of PTSD in post-conflict Timor-Leste: an analysis of the Harvard Trauma Questionnaire. BMC Psychiatry 2017; 17:191. [PMID: 28532449 PMCID: PMC5441051 DOI: 10.1186/s12888-017-1340-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 04/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is the most widely assessed form of mental distress in cross-cultural studies conducted amongst populations exposed to mass conflict and displacement. Nevertheless, there have been longstanding concerns about the universality of PTSD as a diagnostic category when applied across cultures. One approach to examining this question is to assess whether the same factor structure can be identified in culturally diverse populations as has been described in populations of western societies. We examine this issue based on an analysis of the Harvard Trauma Questionnaire (HTQ) completed by a large community sample in conflict-affected Timor-Leste. METHOD Culturally adapted measures were applied to assess exposure to conflict-related traumatic events (TEs), ongoing adversities, symptoms of PTSD and psychological distress, and functional impairment amongst a large population sample (n = 2964, response rate: 82.4%) in post-conflict Timor-Leste. RESULTS Confirmatory factor analyses of the ICD-10, ICD-11, DSM-IV, four-factor Emotional Numbing and five-factor Dysphoric-Arousal PTSD structures, found considerable support for all these models. Based on these classifications, concurrent validity was indicated by logistic regression analyses which showed that being a woman, trauma exposure, ongoing adversity, severe distress, and functional impairment were all associated with PTSD. CONCLUSIONS Although symptom prevalence estimates varied widely based on different classifications, our study found a general agreement in PTSD assignments across contemporary diagnostic systems in a large conflict-affected population in Timor-Leste. Further studies are needed, however, to establish the construct and concurrent validity of PTSD in other cultures.
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Affiliation(s)
- Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW, 2170, Australia.
| | - Mohammed Mohsin
- 0000 0004 4902 0432grid.1005.4Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
| | - Susan Rees
- 0000 0004 4902 0432grid.1005.4Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
| | - Zachary Steel
- 0000 0001 0640 7766grid.418393.4The Black Dog Institute, Sydney, Australia ,St John of God, Richmond Hospital, Richmond, NSW Australia
| | - Natalino Tam
- 0000 0004 4902 0432grid.1005.4Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
| | - Zelia Soares
- 0000 0004 4902 0432grid.1005.4Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
| | - Jessica Baker
- 0000 0004 4902 0432grid.1005.4Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
| | - Derrick Silove
- 0000 0004 4902 0432grid.1005.4Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
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Silove DM, Tay AK, Steel Z, Tam N, Soares Z, Soares C, Dos Reis N, Alves A, Rees S. Symptoms of post-traumatic stress disorder, severe psychological distress, explosive anger and grief amongst partners of survivors of high levels of trauma in post-conflict Timor-Leste. Psychol Med 2017; 47:149-159. [PMID: 27682000 DOI: 10.1017/s0033291716002233] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little is known about the mental health of partners of survivors of high levels of trauma in post-conflict countries. METHOD We studied 677 spouse dyads (n = 1354) drawn from a community survey (response 82.4%) in post-conflict Timor-Leste. We used culturally adapted measures of post-traumatic stress disorder (PTSD), psychological distress, explosive anger and grief. RESULTS Latent class analysis identified three classes of couples: class 1, comprising women with higher trauma events (TEs), men with intermediate TEs (19%); class 2, including men with higher TEs, women with lower TEs (23%); and class 3, comprising couples in which men and women had lower TE exposure (58%) (the reference group). Men and women partners of survivors of higher TE exposure (classes 1 and 2) had increased symptoms of explosive anger and grief compared with the reference class (class 3). Women partners of survivors of higher TE exposure (class 2) had a 20-fold increased rate of PTSD symptoms compared with the reference class, a pattern that was not evident for men living with women exposed to higher levels of trauma (class 1). CONCLUSIONS Men and women living with survivors of higher levels of trauma showed an increase in symptoms of grief and explosive anger. The manifold higher rate of PTSD symptoms amongst women living with men exposed to high levels of trauma requires replication. It is important to assess the mental health of partners when treating survivors of high levels of trauma in post-conflict settings.
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Affiliation(s)
- D M Silove
- Academic Mental Health Unit and Ingham Institute,University of New South Wales and South Western Sydney Local Health District,Level 2, Mental Health Centre,Liverpool Hospital,Sydney, NSW 2170,Australia
| | - A K Tay
- Academic Mental Health Unit and Ingham Institute,University of New South Wales and South Western Sydney Local Health District,Level 2, Mental Health Centre,Liverpool Hospital,Sydney, NSW 2170,Australia
| | - Z Steel
- St John of God Richmond Hospital,School of Psychiatry,University of New South Wales,North Richmond,NSW 2754,Australia
| | - N Tam
- Academic Mental Health Unit and Ingham Institute,University of New South Wales and South Western Sydney Local Health District,Level 2, Mental Health Centre,Liverpool Hospital,Sydney, NSW 2170,Australia
| | - Z Soares
- Alola Foundation,Dili, Timor-Leste
| | - C Soares
- Alola Foundation,Dili, Timor-Leste
| | | | - A Alves
- Alola Foundation,Dili, Timor-Leste
| | - S Rees
- Academic Mental Health Unit and Ingham Institute,University of New South Wales and South Western Sydney Local Health District,Level 2, Mental Health Centre,Liverpool Hospital,Sydney, NSW 2170,Australia
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Schubert SJ, Lee CW, de Araujo G, Butler SR, Taylor G, Drummond PD. The Effectiveness of Eye Movement Desensitization and Reprocessing Therapy to Treat Symptoms Following Trauma in Timor Leste. J Trauma Stress 2016; 29:141-8. [PMID: 26934487 DOI: 10.1002/jts.22084] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 10/23/2015] [Accepted: 12/16/2015] [Indexed: 11/06/2022]
Abstract
The effectiveness of eye movement desensitization and reprocessing (EMDR) therapy for treating trauma symptoms was examined in a postwar/conflict, developing nation, Timor Leste. Participants were 21 Timorese adults with symptoms of posttraumatic stress disorder (PTSD), assessed as those who scored ≥2 on the Harvard Trauma Questionnaire (HTQ). Participants were treated with EMDR therapy. Depression and anxiety symptoms were assessed using the Hopkins Symptom Checklist. Symptom changes post-EMDR treatment were compared to a stabilization control intervention period in which participants served as their own waitlist control. Sessions were 60-90 mins. The average number of sessions was 4.15 (SD = 2.06). Despite difficulties providing treatment cross-culturally (i.e., language barriers), EMDR therapy was followed by significant and large reductions in trauma symptoms (Cohen's d = 2.48), depression (d = 2.09), and anxiety (d = 1.77). At posttreatment, 20 (95.2%) participants scored below the HTQ PTSD cutoff of 2. Reliable reductions in trauma symptoms were reported by 18 participants (85.7%) posttreatment and 16 (76.2%) at 3-month follow-up. Symptoms did not improve during the control period. Findings support the use of EMDR therapy for treatment of adults with PTSD in a cross-cultural, postwar/conflict setting, and suggest that structured trauma treatments can be applied in Timor Leste.
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Affiliation(s)
- Sarah J Schubert
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | - Christopher W Lee
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | | | - Susan R Butler
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | - Graham Taylor
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | - Peter D Drummond
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
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Tay AK, Rees S, Steel Z, Tam N, Soares Z, Soares C, Silove DM. Six-year trajectories of post-traumatic stress and severe psychological distress symptoms and associations with timing of trauma exposure, ongoing adversity and sense of injustice: a latent transition analysis of a community cohort in conflict-affected Timor-Leste. BMJ Open 2016; 6:e010205. [PMID: 26908525 PMCID: PMC4769389 DOI: 10.1136/bmjopen-2015-010205] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To identify the 6-year trajectories of post-traumatic stress symptoms (PTSS) and psychological distress symptoms, and examine for associations with timing of trauma exposure, ongoing adversity and with the sense of injustice in conflict-affected Timor-Leste. SETTING A whole-of-household survey was conducted in 2004 and 2010 in Dili, the capital of Timor-Leste. PARTICIPANTS 1022 adults were followed up over 6 years (retention rate 84.5%). Interviews were conducted by field workers applying measures of traumatic events (TEs), ongoing adversity, a sense of injustice, PTS symptoms and psychological distress. RESULTS Latent transition analysis supported a 3-class longitudinal model (psychological distress, comorbid symptoms and low symptoms). We derived 4 composite trajectories comprising recovery (20.8%), a persisting morbidity trajectory (7.2%), an incident trajectory (37.2%) and a low-symptom trajectory (34.7%). Compared with the low-symptom trajectory, the persistent and incident trajectories reported greater stress arising from poverty and family conflict, higher TE exposure for 2 historical periods, and a sense of injustice for 2 historical periods. The persistent trajectory was unique in reporting greater TE exposure in the Indonesian occupation, whereas the incident trajectory reported greater TE exposure during the later internal conflict that occurred between baseline and follow-up. Compared with the low-symptom trajectory, the incident trajectory reported a greater sense of injustice relating to the periods of the Indonesian occupation and independence. The persistent trajectory was characterised by a sense of injustice relating to the internal conflict and contemporary times. The recovery trajectory was characterised by the absence of these risk factors, the only difference from the low-symptom trajectory being that the former reported a sense of injustice for the period surrounding independence. CONCLUSIONS Our findings suggest that the timing of both TE exposure and the focus of a sense of injustice may differentiate those with persisting and new-onset mental health morbidity in settings of recurrent conflict.
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Affiliation(s)
- AK Tay
- Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, New South Wales, Australia
- Academic Mental Health Unit, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales, Australia
| | - S Rees
- Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, New South Wales, Australia
- Academic Mental Health Unit, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Z Steel
- St John of God Richmond Hospital, School of Psychiatry, University of New South Wales
| | - N Tam
- Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, New South Wales, Australia
- Academic Mental Health Unit, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Z Soares
- Alola Foundation, Dili, Timor-Leste
| | - C Soares
- Alola Foundation, Dili, Timor-Leste
| | - DM Silove
- Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, New South Wales, Australia
- Academic Mental Health Unit, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales, Australia
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Schubert SJ, Lee CW, Drummond PD. Eye Movements Matter, But Why? Psychophysiological Correlates of EMDR Therapy to Treat Trauma in Timor-Leste. JOURNAL OF EMDR PRACTICE AND RESEARCH 2016. [DOI: 10.1891/1933-3196.10.2.70] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This preliminary study examined the physiological correlates of eye movement desensitization and reprocessing (EMDR) therapy when effectively used to treat trauma symptoms in a postconflict, developing nation, Timor-Leste. Participants were 20 Timorese adults with posttraumatic stress disorder (PTSD) symptoms treated with EMDR therapy. PTSD, depression, and anxiety decreased significantly after an average of 4.15 (SD = 2.06) sessions. Continuous measures of heart rate, skin conductance, and respiration were collected during the first and last desensitization sessions. Physiological activity decreased in EMDR desensitization sessions, and eye movement sets were associated with an immediate significant decrease in heart rate and an increase in skin conductance, consistent with an orienting response. This response habituated within and across eye movement sets. These findings suggest that effective EMDR therapy is associated with de-arousal within sessions and that eye movement sets are associated with distinct physiological changes that may aid memory processing. The findings offer insight into the working mechanisms of EMDR when used to treat PTSD symptoms in a real-world, cross-cultural, postwar/conflict setting.
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Mpinga EK, Kandala NB, Hasselgård-Rowe J, Tshimungu Kandolo F, Verloo H, Bukonda NKZ, Chastonay P. Estimating the Costs of Torture: Challenges and Opportunities. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:567-581. [PMID: 26385586 DOI: 10.1007/s40258-015-0196-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Due to its nature, extent and consequences, torture is considered a major public health problem and a serious violation of human rights. Our study aims to set the foundation for a theoretical framework of the costs related to torture. It examines existing challenges and proposes some solutions. Our proposed framework targets policy makers, human rights activists, professionals working in programmes, centres and rehabilitation projects, judges and lawyers, survivors of torture and their families and anyone involved in the prevention and fight against this practice and its consequences. We adopted a methodology previously used in studies investigating the challenges in measuring and valuing productivity costs in health disorders. We identify and discuss conceptual, methodological, political and ethical challenges that studies on the economic and social costs of torture pose and propose alternatives in terms of possible solutions to these challenges. The economic dimension of torture is rarely debated and integrated in research, policies and programmes. Several challenges such as epistemological, methodological, ethical or political ones have often been presented as obstacles to cost studies of torture and as an excuse for not investigating this dimension. In identifying, analysing and proposing solutions to these challenges, we intend to stimulate the integration of the economic dimension in research and prevention of torture strategies.
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Affiliation(s)
- Emmanuel Kabengele Mpinga
- Department of Community Health and Medicine, Faculty of Medicine, Institute of Global Health, University of Geneva, Campus Biotech, Chemin des Mines 9, 1211, Geneva 20, Switzerland.
| | - Ngianga-Bakwin Kandala
- Health Economics and Evidence Synthesis Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
- Department of Mathematics and Information sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK
| | - Jennifer Hasselgård-Rowe
- Department of Community Health and Medicine, Faculty of Medicine, Institute of Global Health, University of Geneva, Campus Biotech, Chemin des Mines 9, 1211, Geneva 20, Switzerland
| | - Félicien Tshimungu Kandolo
- Departement of Public Health, Epidemiology and Health Systems, Institut Supérieur des Techniques Médicales, Kinshasa, Democratic Republic of Congo
| | - Henk Verloo
- Department of Health Sciences La Source, University of Applied Sciences, Lausanne, Switzerland
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Brounéus K. The Women and Peace Hypothesis in Peacebuilding Settings: Attitudes of Women in the Wake of the Rwandan Genocide. SIGNS 2014. [DOI: 10.1086/676918] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dunphy K, Elton M, Jordan A. Exploring Dance/Movement Therapy in Post-Conflict Timor-Leste. AMERICAN JOURNAL OF DANCE THERAPY 2014. [DOI: 10.1007/s10465-014-9175-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Soosay I, Silove D, Bateman-Steel C, Steel Z, Bebbington P, Jones PB, Chey T, Ivancic L, Marnane C. Trauma exposure, PTSD and psychotic-like symptoms in post-conflict Timor Leste: an epidemiological survey. BMC Psychiatry 2012; 12:229. [PMID: 23249370 PMCID: PMC3554511 DOI: 10.1186/1471-244x-12-229] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 12/13/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Studies in developed countries indicate that psychotic-like symptoms are prevalent in the community and are related to trauma exposure and PTSD. No comparable studies have been undertaken in low-income, post-conflict countries. This study aimed to assess the prevalence of psychotic-like symptoms in conflict-affected Timor Leste and to examine whether symptoms were associated with trauma and PTSD. METHODS The Psychosis Screening Questionnaire and the Harvard Trauma Questionnaire (assessing trauma exposure and PTSD) were administered in an epidemiological survey of 1245 adults (response rate 80.6%) in a rural and an urban setting in Timor Leste. We defined PSQ screen-positive cases as those people reporting at least one psychotic-like symptom (paranoia, hallucinations, strange experiences, thought interference, hypomania). RESULTS The prevalence of PSQ screen-positive cases was 12 percent and these persons were more disabled. PSQ cases were more likely to reside in the urban area, experienced higher levels of trauma exposure and a greater prevalence of PTSD. PTSD only partially mediated the relationship between trauma exposure and psychotic-like symptoms. CONCLUSIONS Psychotic-like symptoms may be prevalent in countries exposed to mass conflict. The cultural and contextual meaning of psychotic-like symptoms requires further inquiry in low-income, post-conflict settings such as Timor Leste.
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Affiliation(s)
- Ian Soosay
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
| | - Derrick Silove
- Psychiatry Research & Teaching Unit, University of New South Wales, Liverpool Hospital, Cnr Forbes & Campbell Streets, Liverpool, Australia
| | - Catherine Bateman-Steel
- Psychiatry Research & Teaching Unit, University of New South Wales, Liverpool Hospital, Cnr Forbes & Campbell Streets, Liverpool, Australia
| | - Zachary Steel
- Psychiatry Research & Teaching Unit, University of New South Wales, Liverpool Hospital, Cnr Forbes & Campbell Streets, Liverpool, Australia
| | - Paul Bebbington
- UCL, Mental Health Sciences Unit, Riding House Street, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Hills Road, Cambridge, UK
| | - Tien Chey
- Psychiatry Research & Teaching Unit, University of New South Wales, Liverpool Hospital, Cnr Forbes & Campbell Streets, Liverpool, Australia
| | - Lorraine Ivancic
- Psychiatry Research & Teaching Unit, University of New South Wales, Liverpool Hospital, Cnr Forbes & Campbell Streets, Liverpool, Australia
| | - Claire Marnane
- Psychiatry Research & Teaching Unit, University of New South Wales, Liverpool Hospital, Cnr Forbes & Campbell Streets, Liverpool, Australia
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Abstract
This paper reviews the literature on substance use among populations displaced by conflict. Of the 17 publications presenting primary data retained for review, all consider populations in or recovering from protracted conflict, the majority (10) in non-camp settings. Most studies (10) offer prevalence estimates, suggesting that substance use (such as of alcohol, opiates, or minor tranquilizers) is common in some displaced settings. Five describe harmful consequences of substance use among displaced populations (such as HIV transmission, tuberculosis treatment failure, gender-based violence, and economic problems). Three studies suggest risk factors for substance use problems (such as gender, trauma-related conditions, pre-displacement substance use, and socio-economic factors); two examine qualitatively the gendered nature of alcohol-related harm and its links with gender-based violence. One study examines an intervention. The evidence base is weak. Findings are used to develop a conceptual framework emphasizing the risk environment to inform further research, to encourage debate among researchers and practitioners, and to enable the development of interventions.
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Affiliation(s)
- Nadine Ezard
- London School of Hygiene and Tropical Medicine, United Kingdom.
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17
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Schubert CC, Punamäki RL. Mental health among torture survivors: cultural background, refugee status and gender. Nord J Psychiatry 2011; 65:175-82. [PMID: 20854222 DOI: 10.3109/08039488.2010.514943] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The experience of torture places the survivors at a heightened risk for somatic and mental health problems. AIMS This study examined the role of culture, refugee status and gender in the mental and somatic health among help-seekers in a centre for torture survivors in Finland. METHOD The 78 participants (29 women and 49 men) were interviewed and assessed with the Impact of Event Scale-Revised (IES-R) and the Hopkins Symptom Checklist-25 (HSCL-25) scales and their somatic complaints were registered. Groups with Middle Eastern, Central African, Southern Asian and South Eastern European cultural backgrounds were compared. RESULTS Group differences were found in post-traumatic stress disorder (PTSD) and depressive symptoms and somatic complaints. As hypothesized, Southern European torture survivors showed a higher level of PTSD than cultural groups from more traditional collective societies in Middle East, Asia and Africa, and more depressive symptoms than survivors from a Southern Asian background. Against the hypothesis, South Eastern European subjects reported also more somatic complaints than Central African survivors. Women suffered more from PTSD and depressive symptoms than men in all cultural groups. Asylum-seeking status was marginally associated with anxiety symptoms only in the South Eastern European group. CONCLUSION Health services should consider the influence of culture in the expression of psychological and somatic symptoms and avoid a simplistic distinction between somatic and psychological expressions of pain.
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Affiliation(s)
- Carla C Schubert
- Department of Psychology, University of Tampere, Tampere, FIN-33014, Finland.
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18
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Explosive anger in postconflict Timor Leste: interaction of socio-economic disadvantage and past human rights-related trauma. J Affect Disord 2011; 131:268-76. [PMID: 21310496 DOI: 10.1016/j.jad.2010.12.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 12/30/2010] [Accepted: 12/30/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Countries emerging from major conflict commonly experience recurrent periods of communal instability. A psychosocial theory, Adaptation and Development after Persecution and Trauma (ADAPT), suggests that experiences of past human rights abuses interact with socio-economic disadvantage in the postconflict period to generate or maintain explosive forms of anger. Previous research has supported a link between trauma exposure and anger but the role of ongoing socio-economic disadvantage requires further clarification. METHODS The present study examined a structural equation model based on cross-sectional epidemiological data (n = 1245) collected in post-conflict Timor Leste in 2004. The model included four trauma dimensions derived from a prior factor analysis; a latent variable of post-conflict distress symptoms (derived from measures of PTSD and depression/anxiety); an index of socio-economic distress; and an indigenously-based measure of explosive anger. RESULTS The final model yielded a good fit (chi-square = 26.59 df = 20 p = 0.15 CFI = 0.99; TLI = 0.99; RMSEA = 0.016). Postconflict distress symptoms mediated the associations of trauma dimensions and socio-economic disadvantage with anger. Trauma dimensions associated with human rights violations and witnessing murder were partly mediated by ongoing socio-economic disadvantage in the path to postconflict distress and anger. LIMITATIONS Longitudinal studies will be needed to confirm the chronological sequencing of these relationships. CONCLUSIONS The study offers empirical support for a link between past trauma related to human rights violations and ongoing socio-economic disadvantage in the path to distress and anger.
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19
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Ezard N, Oppenheimer E, Burton A, Schilperoord M, Macdonald D, Adelekan M, Sakarati A, van Ommeren M. Six rapid assessments of alcohol and other substance use in populations displaced by conflict. Confl Health 2011; 5:1. [PMID: 21310092 PMCID: PMC3050731 DOI: 10.1186/1752-1505-5-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 02/11/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance use among populations displaced by conflict is a neglected area of public health. Alcohol, khat, benzodiazepine, opiate, and other substance use have been documented among a range of displaced populations, with wide-reaching health and social impacts. Changing agendas in humanitarian response-including increased prominence of mental health and chronic illness-have so far failed to be translated into meaningful interventions for substance use. METHODS Studies were conducted from 2006 to 2008 in six different settings of protracted displacement, three in Africa (Kenya, Liberia, northern Uganda) and three in Asia (Iran, Pakistan, and Thailand). We used intervention-oriented qualitative Rapid Assessment and Response methods, adapted from two decades of experience among non-displaced populations. The main sources of data were individual and group interviews conducted with a culturally representative (non-probabilistic) sample of community members and service providers. RESULTS Widespread use of alcohol, particularly artisanally-produced alcohol, in Kenya, Liberia, Uganda, and Thailand, and opiates in Iran and Pakistan was believed by participants to be linked to a range of health, social and protection problems, including illness, injury (intentional and unintentional), gender-based violence, risky behaviour for HIV and other sexually transmitted infection and blood-borne virus transmission, as well as detrimental effects to household economy. Displacement experiences, including dispossession, livelihood restriction, hopelessness and uncertain future may make communities particularly vulnerable to substance use and its impact, and changing social norms and networks (including the surrounding population) may result in changed - and potentially more harmful-patterns of use. Limited access to services, including health services, and exclusion from relevant host population programmes, may exacerbate the harmful consequences. CONCLUSIONS The six studies show the feasibility and value of conducting rapid assessments in displaced populations. One outcome of these studies is the development of a UNHCR/WHO field guide on rapid assessment of alcohol and other substance use among conflict-affected populations. More work is required on gathering population-based epidemiological data, and much more experience is required on delivering effective interventions. Presentation of these findings should contribute to increased awareness, improved response, and more vigorous debate around this important but neglected area.
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Affiliation(s)
- Nadine Ezard
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ann Burton
- United Nations High Commissioner for Refugees, Dadaab, Kenya
| | - Marian Schilperoord
- Division of Programme Support and Management, Public Health and HIV Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | | | - Moruf Adelekan
- Consultant Psychiatrist, Royal Blackburn Hospital, Blackburn, UK
| | | | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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20
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Silove D, Brooks R, Bateman CS, Steel Z, Amaral ZFC, Rodger J, Soosay I. Social and trauma-related pathways leading to psychological distress and functional limitations four years after the humanitarian emergency in Timor-Leste. J Trauma Stress 2010; 23:151-60. [PMID: 20146257 DOI: 10.1002/jts.20499] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is growing acknowledgment that research in the postconflict field needs to include a focus on social conditions. The authors applied structural equation modeling to epidemiologic data obtained from postconflict Timor-Leste, to examine for links involving potentially traumatic events and sociodemographic factors (age, gender, educational levels, and unemployment) with psychological symptoms and functioning. Exposure to trauma and lack of education emerged as most relevant with psychological distress impacting on education in the urban area. Age and gender exerted influences at different points in the model consistent with the known history of Timor. Although based on cross-sectional data, the model supports the relevance of past trauma, posttraumatic distress, and postconflict social conditions to functioning in societies such as Timor-Leste.
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Affiliation(s)
- D Silove
- Centre for Population Mental Health Research, Sydney South West Area Health Service and School of Psychiatry, University of New South Wales, New South Wales, Australia.
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21
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Explosive anger as a response to human rights violations in post-conflict Timor-Leste. Soc Sci Med 2009; 69:670-7. [PMID: 19616880 DOI: 10.1016/j.socscimed.2009.06.030] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Indexed: 11/21/2022]
Abstract
Over several decades, clinicians have documented a pattern of explosive anger amongst survivors of gross human rights violations. Yet there is a dearth of epidemiological research investigating explosive anger in post-conflict countries. In the present study undertaken in Timor-Leste between March and November 2004, we identified an indigenous descriptor for explosive anger, including this index in the East Timor Mental Health Epidemiological Needs Study, a small area total population survey of 1544 adults living in an urban and a rural area. Other measures included indices of past trauma events, post-traumatic stress and general psychological distress, and socio-demographic variables. We found that 38% of the population reached the defined threshold of one attack of explosive anger a month (average=1 episode every 2-3 days). Only a minority of persons with explosive anger reached threshold scores for post-traumatic stress and general psychological distress. High levels of trauma exposure represented the strongest predictor of explosive anger. Latent class analysis identified three sub-groups with explosive anger: young trauma-affected adults living in the capital city who were unemployed; an older group, predominantly men, who had experienced extensive violence, including combat, assault and torture; and a less well characterized group of women. The findings offer support for a sequential model of explosive anger in which experiences of past persecution are compounded by frustrations in the post-conflict environment. The data provide a foundation for exploring further the role of trauma-induced anger in the cycles of violence that are prevalent in post-conflict countries.
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22
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Mullet E, Neto F, Pinto MDC. What can reasonably be expected from a truth commission: A preliminary examination of East Timorese views. PEACE AND CONFLICT: JOURNAL OF PEACE PSYCHOLOGY 2008. [DOI: 10.1080/10781910802240717] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Affiliation(s)
- Derrick Silove
- Psychiatry Research and Teaching Unit, Mental Health Centre, Liverpool Hospital, Liverpool, NSW 2170, Australia.
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24
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Steel Z, Silove D, Chey T, Bauman A, Phan T, Phan T. Mental disorders, disability and health service use amongst Vietnamese refugees and the host Australian population. Acta Psychiatr Scand 2005; 111:300-9. [PMID: 15740466 DOI: 10.1111/j.1600-0447.2004.00458.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the prevalence of common mental disorders, disability and health service utilization amongst Vietnamese refugees resettled in Australia for 11 years, with data obtained from a national survey of the host population. METHOD A stratified multistage probability household survey of 1611 Vietnamese undertaken in the state of New South Wales was compared with data from 7961 Australian-born respondents. Measures included the CIDI 2.1 and the MOS SF-12. RESULTS The 12-month prevalence of anxiety, depression and drug and alcohol dependence amongst Vietnamese was 6.1% compared with 16.7% amongst Australians. Vietnamese with a mental illness reported higher disability but exhibited similar levels of mental health consultation. The overall service burden of mental disorders was lower for the Vietnamese. CONCLUSION The findings suggest that refugee groups resettled for some time in Western countries may show sound mental health adaptation and do not necessarily impose a burden on general or mental health services.
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Affiliation(s)
- Z Steel
- Center for Population Mental Health Research, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
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25
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Steel Z, Frommer N, Silove D. Part I--the mental health impacts of migration: the law and its effects failing to understand: refugee determination and the traumatized applicant. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2004; 27:511-528. [PMID: 15560880 DOI: 10.1016/j.ijlp.2004.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Zachary Steel
- School of Psychiatry, University of New South Wales, Australia Center for Population Mental Health Research, Australia.
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26
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Silove D, Manicavasagar V, Baker K, Mausiri M, Soares M, de Carvalho F, Soares A, Fonseca Amiral Z. Indices of social risk among first attenders of an emergency mental health service in post-conflict East Timor: an exploratory investigation. Aust N Z J Psychiatry 2004; 38:929-32. [PMID: 15555027 DOI: 10.1080/j.1440-1614.2004.01483.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Little is known about the profile of patients treated in mental health services in low-income, post-conflict countries, especially in the post-emergency phase. We postulated that patients attending the first community mental health service in East Timor would be characterized not only by mental disturbance but by high levels of social vulnerability. METHOD Drawing on existing methods and on consultations with East Timorese mental health staff, five social indicators were identified: dangerousness; inability to undertake life-sustaining self-care; bizarre behaviour; incapacitating distress; and social unmanageability. Adequate levels of interrater reliability (65-91%) were achieved in identifying these indicators from case notes. Forty-eight randomly selected case notes were analyzed to ascertain the prevalence of social risk factors as well as the referral source and broad diagnostic groupings. RESULTS Major referral sources were the family, humanitarian agencies and the police. Twenty-nine percent met criteria for dangerousness; 42% for inability to undertake self-care; 58% for bizarre behaviour; 75% for distress; and 19% for unmanageability. Ninety-eight percent fulfilled at least one social indicator, with the modal score being 2. CONCLUSIONS Although the approach to documentation and analysis was preliminary, the data suggest that a focus on social risk indicators may assist in determining those mentally disturbed persons in need of priority care in resource-poor post-conflict countries.
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Affiliation(s)
- Derrick Silove
- School of Psychiatry, University of New South Wales, Australia.
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27
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Jaranson JM, Butcher J, Halcon L, Johnson DR, Robertson C, Savik K, Spring M, Westermeyer J. Somali and Oromo refugees: correlates of torture and trauma history. Am J Public Health 2004; 94:591-8. [PMID: 15054011 PMCID: PMC1448304 DOI: 10.2105/ajph.94.4.591] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This cross-sectional, community-based, epidemiological study characterized Somali and Ethiopian (Oromo) refugees in Minnesota to determine torture prevalence and associated problems. METHODS A comprehensive questionnaire was developed, then administered by trained ethnic interviewers to a nonprobability sample of 1134. Measures assessed torture techniques; traumatic events; and social, physical, and psychological problems, including posttraumatic stress symptoms. RESULTS Torture prevalence ranged from 25% to 69% by ethnicity and gender, higher than usually reported. Unexpectedly, women were tortured as often as men. Torture survivors had more health problems, including posttraumatic stress. CONCLUSIONS This study highlights the need to recognize torture in African refugees, especially women, identify indicators of posttraumatic stress in torture survivors, and provide additional resources to care for tortured refugees.
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Affiliation(s)
- James M Jaranson
- HealthPartners Division of Behavioral Health and the Department of Epidemiology, University of Minnesota, Minneapolis, 55454, USA
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28
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Povey G, Mercer MA. East Timor in transition: health and health care. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2003; 32:607-23. [PMID: 12211296 DOI: 10.2190/mayx-00lx-d01v-rjdf] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
East Timor was liberated from 400 years of conquest and exploitation in an armed struggle that ended, in September 1999, in a conflagration that destroyed its social and physical infrastructures. For two years the territory has been under United Nations administration. Political conditions remain unstable as the result of many intrinsic and external factors. Its economy continues to depend upon infusions of funds from multilateral, bilateral, and private sources. Efforts by expatriates to introduce Euro-American cultural and technical models have been applied to the factors that determine health, with modest results. East Timor expects to be totally independent of foreign control early in 2002. Its future health will depend upon continuing collaboration between international and local leadership in evolving effective government, economy, and health services designed, managed, and executed by Timorese.
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Affiliation(s)
- George Povey
- Department of Epidemiology, University of British Columbia, Vancouver, Canada.
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