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Schiller D, Yu ANC, Alia-Klein N, Becker S, Cromwell HC, Dolcos F, Eslinger PJ, Frewen P, Kemp AH, Pace-Schott EF, Raber J, Silton RL, Stefanova E, Williams JHG, Abe N, Aghajani M, Albrecht F, Alexander R, Anders S, Aragón OR, Arias JA, Arzy S, Aue T, Baez S, Balconi M, Ballarini T, Bannister S, Banta MC, Barrett KC, Belzung C, Bensafi M, Booij L, Bookwala J, Boulanger-Bertolus J, Boutros SW, Bräscher AK, Bruno A, Busatto G, Bylsma LM, Caldwell-Harris C, Chan RCK, Cherbuin N, Chiarella J, Cipresso P, Critchley H, Croote DE, Demaree HA, Denson TF, Depue B, Derntl B, Dickson JM, Dolcos S, Drach-Zahavy A, Dubljević O, Eerola T, Ellingsen DM, Fairfield B, Ferdenzi C, Friedman BH, Fu CHY, Gatt JM, de Gelder B, Gendolla GHE, Gilam G, Goldblatt H, Gooding AEK, Gosseries O, Hamm AO, Hanson JL, Hendler T, Herbert C, Hofmann SG, Ibanez A, Joffily M, Jovanovic T, Kahrilas IJ, Kangas M, Katsumi Y, Kensinger E, Kirby LAJ, Koncz R, Koster EHW, Kozlowska K, Krach S, Kret ME, Krippl M, Kusi-Mensah K, Ladouceur CD, Laureys S, Lawrence A, Li CSR, Liddell BJ, Lidhar NK, Lowry CA, Magee K, Marin MF, Mariotti V, Martin LJ, Marusak HA, Mayer AV, Merner AR, Minnier J, Moll J, Morrison RG, Moore M, Mouly AM, Mueller SC, Mühlberger A, Murphy NA, Muscatello MRA, Musser ED, Newton TL, Noll-Hussong M, Norrholm SD, Northoff G, Nusslock R, Okon-Singer H, Olino TM, Ortner C, Owolabi M, Padulo C, Palermo R, Palumbo R, Palumbo S, Papadelis C, Pegna AJ, Pellegrini S, Peltonen K, Penninx BWJH, Pietrini P, Pinna G, Lobo RP, Polnaszek KL, Polyakova M, Rabinak C, Helene Richter S, Richter T, Riva G, Rizzo A, Robinson JL, Rosa P, Sachdev PS, Sato W, Schroeter ML, Schweizer S, Shiban Y, Siddharthan A, Siedlecka E, Smith RC, Soreq H, Spangler DP, Stern ER, Styliadis C, Sullivan GB, Swain JE, Urben S, Van den Stock J, Vander Kooij MA, van Overveld M, Van Rheenen TE, VanElzakker MB, Ventura-Bort C, Verona E, Volk T, Wang Y, Weingast LT, Weymar M, Williams C, Willis ML, Yamashita P, Zahn R, Zupan B, Lowe L. The Human Affectome. Neurosci Biobehav Rev 2024; 158:105450. [PMID: 37925091 PMCID: PMC11003721 DOI: 10.1016/j.neubiorev.2023.105450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023]
Abstract
Over the last decades, theoretical perspectives in the interdisciplinary field of the affective sciences have proliferated rather than converged due to differing assumptions about what human affective phenomena are and how they work. These metaphysical and mechanistic assumptions, shaped by academic context and values, have dictated affective constructs and operationalizations. However, an assumption about the purpose of affective phenomena can guide us to a common set of metaphysical and mechanistic assumptions. In this capstone paper, we home in on a nested teleological principle for human affective phenomena in order to synthesize metaphysical and mechanistic assumptions. Under this framework, human affective phenomena can collectively be considered algorithms that either adjust based on the human comfort zone (affective concerns) or monitor those adaptive processes (affective features). This teleologically-grounded framework offers a principled agenda and launchpad for both organizing existing perspectives and generating new ones. Ultimately, we hope the Human Affectome brings us a step closer to not only an integrated understanding of human affective phenomena, but an integrated field for affective research.
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Affiliation(s)
- Daniela Schiller
- Department of Psychiatry, the Nash Family Department of Neuroscience, and the Friedman Brain Institute, at the Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Alessandra N C Yu
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
| | - Nelly Alia-Klein
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Susanne Becker
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany; Integrative Spinal Research Group, Department of Chiropractic Medicine, University Hospital Balgrist, University of Zurich, Balgrist Campus, Lengghalde 5, 8008 Zurich, Switzerland
| | - Howard C Cromwell
- J.P. Scott Center for Neuroscience, Mind and Behavior, Department of Psychology, Bowling Green State University, Bowling Green, OH 43403, United States
| | - Florin Dolcos
- Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Paul J Eslinger
- Departments of Neurology, Neural & Behavioral Science, Radiology, and Public Health Sciences, Penn State Hershey Medical Center and College of Medicine, Hershey, PA, United States
| | - Paul Frewen
- Departments of Psychiatry, Psychology and Neuroscience at the University of Western Ontario, London, Ontario, Canada
| | - Andrew H Kemp
- School of Psychology, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, United Kingdom
| | - Edward F Pace-Schott
- Harvard Medical School and Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Jacob Raber
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, United States; Departments of Neurology, Radiation Medicine, Psychiatry, and Division of Neuroscience, ONPRC, Oregon Health & Science University, Portland, OR, United States
| | - Rebecca L Silton
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Elka Stefanova
- Faculty of Medicine, University of Belgrade, Serbia; Neurology Clinic, Clinical Center of Serbia, Serbia
| | - Justin H G Williams
- Griffith University, Gold Coast Campus, 1 Parklands Dr, Southport, QLD 4215, Australia
| | - Nobuhito Abe
- Institute for the Future of Human Society, Kyoto University, 46 Shimoadachi-cho, Yoshida Sakyo-ku, Kyoto, Japan
| | - Moji Aghajani
- Institute of Education & Child Studies, Section Forensic Family & Youth Care, Leiden University, the Netherlands; Department of Psychiatry, Amsterdam UMC, Location VUMC, GGZ InGeest Research & Innovation, Amsterdam Neuroscience, the Netherlands
| | - Franziska Albrecht
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Women's Health and Allied Health Professionals Theme, Medical unit Occupational Therapy & Physiotherapy, Stockholm, Sweden
| | - Rebecca Alexander
- Neuroscience Research Australia, Randwick, Sydney, NSW, Australia; Australian National University, Canberra, ACT, Australia
| | - Silke Anders
- Department of Neurology, University of Lübeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Oriana R Aragón
- Yale University, 2 Hillhouse Ave, New Haven, CT, United States; Cincinnati University, Marketing Department, 2906 Woodside Drive, Cincinnati, OH 45221-0145, United States
| | - Juan A Arias
- School of Psychology, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, United Kingdom; Department of Statistics, Mathematical Analysis, and Operational Research, Universidade de Santiago de Compostela, Spain; The Galician Center for Mathematical Research and Technology (CITMAga), 15782 Santiago de Compostela, Spain
| | - Shahar Arzy
- Department of Medical Neurobiology, Hebrew University, Jerusalem, Israel
| | - Tatjana Aue
- Institute of Psychology, University of Bern, Fabrikstr. 8, 3012 Bern, Switzerland
| | | | - Michela Balconi
- International Research Center for Cognitive Applied Neuroscience, Catholic University of Milan, Milan, Italy
| | - Tommaso Ballarini
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Scott Bannister
- Durham University, Palace Green, DH1 RL3 Durham, United Kingdom
| | | | - Karen Caplovitz Barrett
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO, United States; Department of Community & Behavioral Health, Colorado School of Public Health, Denver, CO, United States
| | | | - Moustafa Bensafi
- Research Center in Neurosciences of Lyon, CNRS UMR5292, INSERM U1028, Claude Bernard University Lyon 1, Lyon, Centre Hospitalier Le Vinatier, 95 bd Pinel, 69675 Bron Cedex, France
| | - Linda Booij
- Department of Psychology, Concordia University, Montreal, Canada; CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Jamila Bookwala
- Department of Psychology, Lafayette College, Easton, PA, United States
| | - Julie Boulanger-Bertolus
- Department of Anesthesiology and Center for Consciousness Science, University of Michigan, Ann Arbor, MI, United States
| | - Sydney Weber Boutros
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, United States
| | - Anne-Kathrin Bräscher
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Wallstr. 3, 55122 Mainz, Germany; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Antonio Bruno
- Department of Biomedical, Dental Sciences and Morpho-Functional Imaging - University of Messina, Italy
| | - Geraldo Busatto
- Laboratory of Psychiatric Neuroimaging (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lauren M Bylsma
- Departments of Psychiatry and Psychology; and the Center for Neural Basis of Cognition, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | | | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health, and Wellbeing, Australian National University, Canberra, ACT, Australia
| | - Julian Chiarella
- Department of Psychology, Concordia University, Montreal, Canada; CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab., Istituto Auxologico Italiano (IRCCS), Milan, Italy; Department of Psychology, University of Turin, Turin, Italy
| | - Hugo Critchley
- Psychiatry, Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Sussex, United Kingdom
| | - Denise E Croote
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai and Friedman Brain Institute, New York, NY 10029, United States; Hospital Universitário Gaffrée e Guinle, Universidade do Rio de Janeiro, Brazil
| | - Heath A Demaree
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Thomas F Denson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Brendan Depue
- Departments of Psychological and Brain Sciences and Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, United States
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany
| | - Joanne M Dickson
- Edith Cowan University, Psychology Discipline, School of Arts and Humanities, 270 Joondalup Dr, Joondalup, WA 6027, Australia
| | - Sanda Dolcos
- Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Anat Drach-Zahavy
- The Faculty of Health and Welfare Sciences, University of Haifa, Haifa, Israel
| | - Olga Dubljević
- Neurology Clinic, Clinical Center of Serbia, Serbia; Institute for Biological Research "Siniša Stanković", National Institute of Republic of Serbia, Belgrade, Serbia
| | - Tuomas Eerola
- Durham University, Palace Green, DH1 RL3 Durham, United Kingdom
| | - Dan-Mikael Ellingsen
- Department of Diagnostic Physics, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Beth Fairfield
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy; UniCamillus, International Medical University, Rome, Italy
| | - Camille Ferdenzi
- Research Center in Neurosciences of Lyon, CNRS UMR5292, INSERM U1028, Claude Bernard University Lyon 1, Lyon, Centre Hospitalier Le Vinatier, 95 bd Pinel, 69675 Bron Cedex, France
| | - Bruce H Friedman
- Department of Psychology, Virginia Tech, Blacksburg, VA, United States
| | - Cynthia H Y Fu
- School of Psychology, University of East London, United Kingdom; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Justine M Gatt
- Neuroscience Research Australia, Randwick, Sydney, NSW, Australia; School of Psychology, University of New South Wales, Randwick, Sydney, NSW, Australia
| | - Beatrice de Gelder
- Department of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Guido H E Gendolla
- Geneva Motivation Lab, University of Geneva, FPSE, Section of Psychology, CH-1211 Geneva 4, Switzerland
| | - Gadi Gilam
- The Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, CA, United States
| | - Hadass Goldblatt
- Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | | | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liege, Liege, Belgium
| | - Alfons O Hamm
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Jamie L Hanson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15206, United States
| | - Talma Hendler
- Tel Aviv Center for Brain Function, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Cornelia Herbert
- Department of Applied Emotion and Motivation Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Stefan G Hofmann
- Department of Clinical Psychology, Philipps University Marburg, Germany
| | - Agustin Ibanez
- Universidad de San Andres, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile; Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), United States and Trinity Collegue Dublin (TCD), Ireland
| | - Mateus Joffily
- Groupe d'Analyse et de Théorie Economique (GATE), 93 Chemin des Mouilles, 69130 Écully, France
| | - Tanja Jovanovic
- Department of Psychiatry and Behavaioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Ian J Kahrilas
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Maria Kangas
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Yuta Katsumi
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Elizabeth Kensinger
- Department of Psychology and Neuroscience, Boston College, Boston, MA, United States
| | - Lauren A J Kirby
- Department of Psychology and Counseling, University of Texas at Tyler, Tyler, TX, United States
| | - Rebecca Koncz
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia; Specialty of Psychiatry, The University of Sydney, Concord, New South Wales, Australia
| | - Ernst H W Koster
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | | | - Sören Krach
- Social Neuroscience Lab, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Mariska E Kret
- Leiden University, Cognitive Psychology, Pieter de la Court, Waassenaarseweg 52, Leiden 2333 AK, the Netherlands
| | - Martin Krippl
- Faculty of Natural Sciences, Department of Psychology, Otto von Guericke University Magdeburg, Universitätsplatz 2, Magdeburg, Germany
| | - Kwabena Kusi-Mensah
- Department of Psychiatry, Komfo Anokye Teaching Hospital, P. O. Box 1934, Kumasi, Ghana; Department of Psychiatry, University of Cambridge, Darwin College, Silver Street, CB3 9EU Cambridge, United Kingdom; Behavioural Sciences Department, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Cecile D Ladouceur
- Departments of Psychiatry and Psychology and the Center for Neural Basis of Cognition (CNBC), University of Pittsburgh, Pittsburgh, PA, United States
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liege, Liege, Belgium
| | - Alistair Lawrence
- Scotland's Rural College, King's Buildings, Edinburgh, Scotland; The Roslin Institute, University of Edinburgh, Easter Bush, Scotland
| | - Chiang-Shan R Li
- Connecticut Mental Health Centre, Yale University, New Haven, CT, United States
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, Randwick, Sydney, NSW, Australia
| | - Navdeep K Lidhar
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Christopher A Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, United States
| | - Kelsey Magee
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Marie-France Marin
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada; Research Center, Institut universitaire en santé mentale de Montréal, Montreal, Canada
| | - Veronica Mariotti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Loren J Martin
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Hilary A Marusak
- Department of Psychiatry and Behavaioral Neurosciences, Wayne State University, Detroit, MI, United States; Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, MI, United States
| | - Annalina V Mayer
- Social Neuroscience Lab, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Amanda R Merner
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Jessica Minnier
- School of Public Health, Oregon Health & Science University, Portland, OR, United States
| | - Jorge Moll
- Cognitive Neuroscience and Neuroinformatics Unit, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Robert G Morrison
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Matthew Moore
- Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States; War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Anne-Marie Mouly
- Lyon Neuroscience Research Center, CNRS-UMR 5292, INSERM U1028, Universite Lyon, Lyon, France
| | - Sven C Mueller
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Andreas Mühlberger
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Regensburg, Germany
| | - Nora A Murphy
- Department of Psychology, Loyola Marymount University, Los Angeles, CA, United States
| | | | - Erica D Musser
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, United States
| | - Tamara L Newton
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States
| | - Michael Noll-Hussong
- Psychosomatic Medicine and Psychotherapy, TU Muenchen, Langerstrasse 3, D-81675 Muenchen, Germany
| | - Seth Davin Norrholm
- Department of Psychiatry and Behavaioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, University of Ottawa Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Canada
| | - Robin Nusslock
- Department of Psychology and Institute for Policy Research, Northwestern University, 2029 Sheridan Road, Evanston, IL, United States
| | - Hadas Okon-Singer
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Thomas M Olino
- Department of Psychology, Temple University, 1701N. 13th St, Philadelphia, PA, United States
| | - Catherine Ortner
- Thompson Rivers University, Department of Psychology, 805 TRU Way, Kamloops, BC, Canada
| | - Mayowa Owolabi
- Department of Medicine and Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan; University College Hospital, Ibadan, Oyo State, Nigeria; Blossom Specialist Medical Center Ibadan, Oyo State, Nigeria
| | - Caterina Padulo
- Department of Psychological, Health and Territorial Sciences, University of Chieti, Chieti, Italy
| | - Romina Palermo
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Rocco Palumbo
- Department of Psychological, Health and Territorial Sciences, University of Chieti, Chieti, Italy
| | - Sara Palumbo
- Department of Surgical, Medical and Molecular Pathology and of Critical Care, University of Pisa, Pisa, Italy
| | - Christos Papadelis
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States
| | - Alan J Pegna
- School of Psychology, University of Queensland, Saint Lucia, Queensland, Australia
| | - Silvia Pellegrini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Kirsi Peltonen
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland; INVEST Research Flagship, University of Turku, Turku, Finland
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Location VUMC, GGZ InGeest Research & Innovation, Amsterdam Neuroscience, the Netherlands
| | | | - Graziano Pinna
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Rosario Pintos Lobo
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, United States
| | - Kelly L Polnaszek
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Maryna Polyakova
- Neurology Department, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Christine Rabinak
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, United States
| | - S Helene Richter
- Department of Behavioural Biology, University of Münster, Badestraße 13, Münster, Germany
| | - Thalia Richter
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab., Istituto Auxologico Italiano (IRCCS), Milan, Italy; Humane Technology Lab., Università Cattolica del Sacro Cuore, Milan, Italy
| | - Amelia Rizzo
- Department of Biomedical, Dental Sciences and Morpho-Functional Imaging - University of Messina, Italy
| | | | - Pedro Rosa
- Laboratory of Psychiatric Neuroimaging (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, Australia
| | - Wataru Sato
- Psychological Process Research Team, Guardian Robot Project, RIKEN, 2-2-2 Hikaridai, Seika-cho, Soraku-gun, Kyoto, Japan
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Susanne Schweizer
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom; School of Psychology, University of New South Wales, Sydney, Australia
| | - Youssef Shiban
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Regensburg, Germany; Department of Psychology (Clinical Psychology and Psychotherapy Research), PFH - Private University of Applied Sciences, Gottingen, Germany
| | - Advaith Siddharthan
- Knowledge Media Institute, The Open University, Milton Keynes MK7 6AA, United Kingdom
| | - Ewa Siedlecka
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Robert C Smith
- Departments of Medicine and Psychiatry, Michigan State University, East Lansing, MI, United States
| | - Hermona Soreq
- Department of Biological Chemistry, Edmond and Lily Safra Center of Brain Science and The Institute of Life Sciences, Hebrew University, Jerusalem, Israel
| | - Derek P Spangler
- Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, United States
| | - Emily R Stern
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States; New York University School of Medicine, New York, NY, United States
| | - Charis Styliadis
- Neuroscience of Cognition and Affection group, Lab of Medical Physics and Digital Innovation, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - James E Swain
- Departments of Psychiatry & Behavioral Health, Psychology, Obstetrics, Gynecology & Reproductive Medicine, and Program in Public Health, Renaissance School of Medicine at Stony Brook University, New York, United States
| | - Sébastien Urben
- Division of Child and Adolescent Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Jan Van den Stock
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Michael A Vander Kooij
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, Universitatsmedizin der Johannes Guttenberg University Medical Center, Mainz, Germany
| | | | - Tamsyn E Van Rheenen
- University of Melbourne, Melbourne Neuropsychiatry Centre, Department of Psychiatry, 161 Barry Street, Carlton, VIC, Australia
| | - Michael B VanElzakker
- Division of Neurotherapeutics, Massachusetts General Hospital, Boston, MA, United States
| | - Carlos Ventura-Bort
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Edelyn Verona
- Department of Psychology, University of South Florida, Tampa, FL, United States
| | - Tyler Volk
- Professor Emeritus of Biology and Environmental Studies, New York University, New York, NY, United States
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Leah T Weingast
- Department of Social Work and Human Services and the Department of Psychological Sciences, Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, United States
| | - Mathias Weymar
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany; Faculty of Health Sciences Brandenburg, University of Potsdam, Germany
| | - Claire Williams
- School of Psychology, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, United Kingdom; Elysium Neurological Services, Elysium Healthcare, The Avalon Centre, United Kingdom
| | - Megan L Willis
- School of Behavioural and Health Sciences, Australian Catholic University, Sydney, NSW, Australia
| | - Paula Yamashita
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, United States
| | - Roland Zahn
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Barbra Zupan
- Central Queensland University, School of Health, Medical and Applied Sciences, Bruce Highway, Rockhampton, QLD, Australia
| | - Leroy Lowe
- Neuroqualia (NGO), Truro, Nova Scotia, Canada.
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Liddell BJ, Das P, Malhi GS, Felmingham KL, Outhred T, Cheung J, Den M, Nickerson A, Askovic M, Aroche J, Coello M, Bryant RA. Opponent intrinsic brain network connectivity profiles associated with posttraumatic fear and dysphoria symptoms in trauma-exposed refugees. Psychol Trauma 2023:2024-22679-001. [PMID: 37917447 DOI: 10.1037/tra0001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Resting-state functional magnetic resonance imaging (rsfMRI) studies report functional alterations in the connectivity between intrinsic brain networks in posttraumatic stress disorder (PTSD), but PTSD heterogeneity is rarely considered. Evidence points to fear (e.g., reexperiencing) and dysphoria (e.g., withdrawal) symptom factors as important in PTSD presentations, including relating to variable emotion dysregulation patterns. This study, therefore, tested how fear and dysphoria posttraumatic symptoms were differentially associated with core network connectivity and emotion dysregulation behaviors in a large group of trauma-exposed refugees. METHOD A final sample of 77 trauma-exposed participants completed a rsfMRI scan. Independent component analysis identified active networks and functional network connectivity (FNC) between networks was assessed. Fear and dysphoria posttraumatic symptoms were partially correlated with FNCs, and linear regression models examined relationships with self-reported difficulties in emotion regulation. RESULTS Twenty-three active networks were identified, eight being in the networks of interest (p < .05 false discovery rate-corrected). Fear and dysphoria symptoms were specifically related to connectivity patterns between two subnetworks of the default mode network (DMN). Fear symptoms were negatively associated with anterior dorsomedial DMN (admDMN) and temporoparietal DMN (tpDMN) connectivity; whereas dysphoria symptoms were positively associated with admDMN-tpDMN connectivity. Additionally, admDMN-tpDMN connectivity was positively predicted by goal-directed emotion dysregulation but negatively predicted by poor emotional clarity. CONCLUSIONS Fear and dysphoria posttraumatic symptoms showed opponent associations with admDMN and tpDMN connectivity, potentially reflecting patterns of under- and overemotion dysregulation associated with these symptom profiles respectively. Findings highlight the importance of considering posttraumatic heterogeneity when constructing neural models of PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Pritha Das
- School of Psychology, University of New South Wales
| | - Gin S Malhi
- Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District
| | | | - Tim Outhred
- Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District
| | | | - Miriam Den
- School of Psychology, University of New South Wales
| | | | - Mirjana Askovic
- NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS)
| | - Jorge Aroche
- NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS)
| | - Mariano Coello
- NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS)
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Nickerson A, Byrow Y, O’Donnell M, Bryant RA, Mau V, McMahon T, Hoffman J, Mastrogiovanni N, Specker P, Liddell BJ. The mental health effects of changing from insecure to secure visas for refugees. Aust N Z J Psychiatry 2023; 57:1486-1495. [PMID: 37248738 PMCID: PMC10619169 DOI: 10.1177/00048674231177950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE In response to growing numbers of refugees worldwide, host governments are increasingly implementing temporary protection policies; however, little is known regarding the mental health impact of these policies. This online longitudinal study investigated whether refugees who transitioned from low visa security (e.g. short-term transient visas) to medium (e.g. temporary protection visas) or high visa (e.g. permanent visas) security showed changes in depression symptoms, social difficulties and immigration-related fears. METHODS Participants were 1,201 refugees and asylum-seekers from Arabic, Farsi, Tamil or English-speaking backgrounds. Study variables were measured prior to and after change in visa status (6 months apart). RESULTS Refugees who transitioned from low to medium security visas showed reduced immigration-related fear (B = -0.09, 95% confidence interval = -0.29 to -0.06), but no change in depression symptoms or social difficulties compared to those who retained low visa security. Refugees who transitioned from low to high security visas showed reduced depression symptoms (B = -0.02, 95% confidence interval = -0.04 to -0.01), social difficulties (B = -0.04, 95% confidence interval = -0.05 to -0.01) and immigration-related fear (B = -0.03, 95% confidence interval = -0.06 to -0.01) compared to those who retained low visa security. CONCLUSION Findings indicate that the increased security afforded by temporary protection policies (vs short-term transient visas) did not translate into improved mental health and social outcomes for refugees. In contrast, permanent protection was associated with significant improvements in psychological and social functioning. These results have important policy implications for countries who have committed to protect and facilitate improved mental health among refugees.
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Affiliation(s)
- Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Yulisha Byrow
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Meaghan O’Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, Carlton, Victoria, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville VIC, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Vicki Mau
- Australian Red Cross, North Melbourne, VIC, Australia
| | - Tadgh McMahon
- SSI, Ashfield, NSW, Australia
- College of Public Health and Medicine, Flinders University, Adelaide, SA, Australia
| | - Joel Hoffman
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | | | - Philippa Specker
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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Hoffman J, Liddell BJ, Keegan D, Kashyap S, Diah Tricesaria AAI, Pestalozzi Z, Argadianti R, Nandyatama RW, Khakbaz M, Nilasari N, Nickerson A. The impact of COVID-19 stressors on refugee mental health and well-being in the context of sustained displacement. Am J Orthopsychiatry 2023; 93:144-155. [PMID: 36634011 DOI: 10.1037/ort0000664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Refugees and asylum seekers in contexts of sustained displacement represent particularly vulnerable communities during the COVID-19 pandemic. The aim of this study was to identify profiles of COVID-19 stressors in refugees in a transit context (i.e., Indonesia) and examine the relationship between these profiles of stressors and mental health and well-being. Participants in this study included 913 refugees and asylum seekers living in Indonesia. The study was completed online in five languages (i.e., Arabic, Dari, Farsi, Somali, and English). A latent class analysis was implemented with 12 COVID-19 stressors representing indicator variables to identify profiles of COVID-19-related stressors experienced. Associations between COVID-19 classes and mental health (posttraumatic stress disorder, depression, anxiety) and well-being (physical and mental) outcomes were investigated. A five-class solution was identified as providing the best fit to the data as follows: (a) a high-COVID stressors class (18.1%), (b) a high access stressors class (13.2%), (c) an infection stressors class (22.7%), (d) a moderate access stressors class (23.1%), and (e) a low-COVID stressors class (22.8%). Membership of all classes reporting at least moderate levels of COVID-19 stressors was associated with greater mental health difficulties and lower physical and mental well-being than the low-COVID stressors class. Results indicated that the severity and type of stressors differed between groups suggesting heterogeneous experiences of the pandemic. Classes also differed according to contextual and social factors such as negative social support, language, and geographic area. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Zico Pestalozzi
- Indonesian Civil Society Network for Refugee Rights Protection (SUAKA)
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5
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Liddell BJ, Das P, Malhi GS, Nickerson A, Felmingham KL, Askovic M, Aroche J, Coello M, Cheung J, Den M, Outhred T, Bryant RA. Refugee visa insecurity disrupts the brain's default mode network. Eur J Psychotraumatol 2023; 14:2213595. [PMID: 37289090 PMCID: PMC10251781 DOI: 10.1080/20008066.2023.2213595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/17/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Research has largely focused on the psychological consequences of refugee trauma exposure, but refugees living with visa insecurity face an uncertain future that also adversely affects psychological functioning and self-determination. OBJECTIVE This study aimed to examine how refugee visa insecurity affects the functional brain. METHOD We measured resting state brain activity via fMRI in 47 refugees with insecure visas (i.e. temporary visa status) and 52 refugees with secure visas (i.e. permanent visa status) residing in Australia, matched on key demographic, trauma exposure and psychopathology. Data analysis comprised independent components analysis to identify active networks and dynamic functional causal modelling tested visa security group differences in network connectivity. RESULTS We found that visa insecurity specifically affected sub-systems within the default mode network (DMN) - an intrinsic network subserving self-referential processes and mental simulations about the future. The insecure visa group showed less spectral power in the low frequency band in the anterior ventromedial DMN, and reduced activity in the posterior frontal DMN, compared to the secure visa group. Using functional dynamic causal modelling, we observed positive coupling between the anterior and posterior midline DMN hubs in the secure visa group, while the insecure visa group displayed negative coupling that correlated with self-reported fear of future deportation. CONCLUSIONS Living with visa-related uncertainty appears to undermine synchrony between anterior-posterior midline components of the DMN responsible for governing the construction of the self and making mental representations of the future. This could represent a neural signature of refugee visa insecurity, which is marked by a perception of living in limbo and a truncated sense of the future.
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Affiliation(s)
| | - Pritha Das
- Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, Australia
- Academic Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia
- CADE Clinic, Royal North Shore Hospital, St Leonards, Australia
| | - Gin S. Malhi
- Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, Australia
- Academic Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia
- CADE Clinic, Royal North Shore Hospital, St Leonards, Australia
| | | | - Kim L. Felmingham
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Mirjana Askovic
- NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, Australia
| | - Jorge Aroche
- NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, Australia
| | - Mariano Coello
- NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, Australia
| | | | - Miriam Den
- School of Psychology, UNSW Sydney, Sydney, Australia
| | - Tim Outhred
- Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, Australia
- Academic Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia
- CADE Clinic, Royal North Shore Hospital, St Leonards, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nickerson A, Byrow Y, Hoffman J, O'Donnell M, Bryant RA, Mastrogiovanni N, McMahon T, Benson G, Mau V, Liddell BJ. The longitudinal association between moral injury appraisals and psychological outcomes in refugees. Psychol Med 2022; 52:2352-2364. [PMID: 33261693 DOI: 10.1017/s0033291720004262] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Refugees report a diverse array of psychological responses following persecution and displacement. Little is known, however, regarding the mechanisms that underlie differential psychological reactions in refugees. This study investigated the longitudinal impact of negative moral appraisals about one's own actions [i.e. moral injury-self (MI-self) appraisals] and others' actions [i.e. moral injury-other (MI-others) appraisals] on a variety of psychological symptoms over a period of 6 months. METHODS Participants were 1085 Arabic, Farsi, Tamil, or English-speaking refugees who completed a survey at baseline and 6 months later either on-line or via pen-and-paper. The survey indexed demographic factors, exposure to potentially traumatic events (PTEs), exposure to ongoing stressors, MI-other appraisals, MI-self appraisals, re-experiencing and arousal symptoms, and feelings of sadness, anger and shame. RESULTS Findings indicated that, after controlling for demographics, PTE exposure and ongoing stressors, MI-other appraisals predicted increased re-experiencing and hyperarousal symptoms, and feelings of sadness and shame. MI-self appraisals predicted decreased feelings of shame, and decreased re-experiencing symptoms. In contrast, psychological symptoms at baseline did not as strongly influence MI appraisals 6 months later. CONCLUSIONS These findings highlight the important role that cognitive appraisals of adverse events play in the longitudinal course of psychological symptoms. These results thus have important implications for the development of tailored psychological interventions to alleviate the mental health burden held by refugees.
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Affiliation(s)
- Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW Australia
| | - Yulisha Byrow
- School of Psychology, University of New South Wales, Sydney, NSW Australia
| | - Joel Hoffman
- School of Psychology, University of New South Wales, Sydney, NSW Australia
| | - Meaghan O'Donnell
- Phoenix Australia, University of Melbourne, Parkville, VIC, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW Australia
| | | | - Tadgh McMahon
- Settlement Services International, Ashfield, NSW, Australia
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Greg Benson
- Settlement Services International, Ashfield, NSW, Australia
| | - Vicki Mau
- Australian Red Cross, North Melbourne, VIC, Australia
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, Sydney, NSW Australia
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Nickerson A, Byrow Y, O'Donnell M, Bryant RA, Mau V, McMahon T, Benson G, Liddell BJ. Cognitive mechanisms underlying the association between trauma exposure, mental health and social engagement in refugees: A longitudinal investigation. J Affect Disord 2022; 307:20-28. [PMID: 35341811 DOI: 10.1016/j.jad.2022.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 01/23/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUNDS Refugees and asylum-seekers are at heightened risk for developing psychological symptoms following exposure to trauma and displacement. Despite this, relatively little is known about the cognitive mechanisms that underlie common mental disorders in refugees. METHODS In this study, we investigated the associations between self-efficacy, beliefs about others (relating to benevolence and trust) and psychological and social outcomes in 1079 refugees from Arabic, Farsi, Tamil or English-speaking backgrounds who were residing in Australia. Participants completed an online survey assessing exposure to potentially traumatic events (PTEs), at baseline (T1), and self-efficacy, beliefs about others, PTSD symptoms, depression symptoms, anger and social engagement at baseline (T1) and six months later (T2). RESULTS A path analysis revealed that greater PTE exposure was associated with lower self-efficacy and lower positive beliefs about others at T1. Self-efficacy at T1 was negatively associated with depression and anger at T2, while positive beliefs about others at T1 were positively associated with social engagement and greater depression symptoms at T2. LIMITATIONS Limitations of this study included the fact that the study sample was not necessarily representative of the broader refugee population, and in particular may have overrepresented those with higher education levels. CONCLUSIONS Findings point to the critical role that cognitive variables play in the maintenance of psychological symptoms in forcibly displaced persons, and highlight the importance of targeting these in psychological interventions to promote positive posttraumatic mental health.
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Affiliation(s)
- Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.
| | - Yulisha Byrow
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Meaghan O'Donnell
- Phoenix Australia, University of Melbourne, Parkville, VIC, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Vicki Mau
- Australian Red Cross, North Melbourne, VIC, Australia
| | - Tadgh McMahon
- Settlement Services International, Ashfield, NSW, Australia; Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Greg Benson
- Settlement Services International, Ashfield, NSW, Australia
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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Liddell BJ, Batch N, Hellyer S, Bulnes-Diez M, Kamte A, Klassen C, Wong J, Byrow Y, Nickerson A. Understanding the effects of being separated from family on refugees in Australia: a qualitative study. Aust N Z J Public Health 2022; 46:647-653. [PMID: 35357742 DOI: 10.1111/1753-6405.13232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To understand the impact of family separation on refugees living in Australia. METHOD Thirteen participants with a refugee background and experiencing separation from family participated in a semi-structured qualitative interview. Interviews were coded and a thematic analysis was conducted using NVivo software. RESULTS Identified themes were organised under four domains. Domain 1 focused on the personal impact of family separation. Themes were the effects on mental health and functioning, driven by incessant worrying about the safety of family and the absence of key attachment figures, the specific effects of having missing family, alterations to self-identity and family dynamics. Domain 2 focused on themes relating to actions taken to find missing family, connect or reunite with separated family. Domain 3 highlighted the coping strategies, support mechanisms and protective factors used by participants. Domain 4 identified core beliefs about the importance of family unity, focusing on security, settlement and a happy future. CONCLUSIONS Family separation has an enduring effect on the wellbeing of refugees, with key pathways being ongoing fear and insecurity, disrupted social attachments and identity shifts in relation to the future self. IMPLICATIONS FOR PUBLIC HEALTH Refugees separated from or missing family struggle with ongoing stress and adjustment issues.
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Affiliation(s)
| | | | | | | | | | - Christina Klassen
- School of Psychology, UNSW Sydney, New South Wales.,Transcultural Psychiatry, McGill University, Canada
| | - Joshua Wong
- School of Psychology, UNSW Sydney, New South Wales
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10
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Liddell BJ, Malhi GS, Felmingham KL, Den ML, Das P, Outhred T, Nickerson A, Askovic M, Coello M, Aroche J, Bryant RA. Activating the attachment system modulates neural responses to threat in refugees with PTSD. Soc Cogn Affect Neurosci 2021; 16:1244-1255. [PMID: 34160037 PMCID: PMC8717059 DOI: 10.1093/scan/nsab077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 03/08/2021] [Accepted: 06/22/2021] [Indexed: 11/12/2022] Open
Abstract
Social attachment systems are disrupted for refugees through trauma and forced displacement. This study tested how the attachment system mitigates neural responses to threat in refugees with posttraumatic stress disorder (PTSD). Refugees with PTSD (N = 28) and refugee trauma-exposed controls (N = 22) viewed threat-related stimuli primed by attachment cues during a functional magnetic resonance imaging scan. Group differences and the moderating effects of avoidant or anxious attachment style and grief related to separation from family on brain activity and connectivity patterns were examined. Separation grief was associated with increased amygdala but decreased ventromedial prefrontal cortical (VMPFC) activity to the attachment prime and decreased VMPFC and hippocampal activity to attachment primed threat in the PTSD (vs trauma-exposed control) group. Avoidant attachment style was connected with increased dorsal frontoparietal attention regional activity to attachment prime cues in the PTSD group. Anxious attachment style was associated with reduced left amygdala connectivity with left medial prefrontal regions to attachment primed threat in the PTSD group. Separation grief appears to reduce attachment buffering of threat reactivity in refugees with PTSD, while avoidant and anxious attachment style modulated attentional and prefrontal regulatory mechanisms in PTSD, respectively. Considering social attachments in refugees could be important to post-trauma recovery, based within changes in key emotion regulation brain systems.
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Affiliation(s)
| | - Gin S Malhi
- Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia
- Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Kim L Felmingham
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Miriam L Den
- School of Psychology, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Pritha Das
- Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia
- Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Tim Outhred
- Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia
- Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | | | - Mirjana Askovic
- NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, Carramar, NSW 2163, Australia
| | - Mariano Coello
- NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, Carramar, NSW 2163, Australia
| | - Jorge Aroche
- NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, Carramar, NSW 2163, Australia
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Abstract
Previous studies have shown that activating the attachment system attenuates fear learning. This study aimed to explore whether attachment priming can also impact on fear extinction processes, which underpin the management of anxiety disorders. In this study, 81 participants underwent a standard fear conditioning and extinction protocol on day 1 and returned 24 h later for an extinction recall and reinstatement test. Half the participants were primed to imagine their closest attachment figure prior to undergoing extinction training, while the other half were instructed to imagine a positive situation. Fear-potentiated startle and subjective expectancies of shock were measured as the primary indicators of fear. Attachment priming led to less relapse during the reinstatement test at the physiological but not subjective levels. These findings have translational potential to imply that activating awareness of attachment figures might augment long-term safety memories acquired in existing treatments to reduce relapse of fear.
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Abstract
BACKGROUND Recent studies have found that attachment security primes can inhibit fear acquisition. This current study aimed to examine whether a brief imaginal prime of one's attachment figure could impact on fear consolidation. METHODS A total of 75 participants underwent fear conditioning on Day 1 and fear recall was tested on Day 2. Immediately following conditioning, half the participants were instructed to imagine an attachment figure while the other half imagined a nonattachment positive situation. Fear-potentiated startle and subjective expectancy of shock ratings were used as the measures of fear learning across trials. RESULTS The attachment group showed significantly lower levels of fear recall on Day 2 at both physiological and subjective levels. Furthermore, this effect was moderated by attachment anxiety, such that it was greatest for individuals who were securely attached. CONCLUSIONS These findings suggest that attachment relationships are protective during the consolidation of fear memories, and may have implications for how social attachments may impact how anxiety disorders can develop.
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Affiliation(s)
- Metaxia Toumbelekis
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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13
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Liddell BJ, Byrow Y, O'Donnell M, Mau V, Batch N, McMahon T, Bryant R, Nickerson A. Mechanisms underlying the mental health impact of family separation on resettled refugees. Aust N Z J Psychiatry 2021; 55:699-710. [PMID: 33111540 DOI: 10.1177/0004867420967427] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Many refugees experience prolonged separation from family members, which research suggests has adverse effects on mental health and post-displacement outcomes in refugee populations. We examine mental health differences in refugees separated and not separated from their families, and key post-migration factors and cultural mechanisms that may underlie this impact. METHODS A sample of 1085 refugees resettled in Australia, of which 23.3% were separated from all of their immediate family, took part in an online battery of survey measures indexing pre- and post-migration refugee experiences, mental health symptoms, disability and individualistic/collectivistic self-identity. Family separation was used as a predictor of mental health outcomes in a series of linear regressions, and the separated and non-separated groups were compared in multigroup path analysis models to examine group-specific indirect effects. RESULTS The separated group reported greater exposure to pre-migration potentially traumatic events and higher levels of post-migration living difficulties compared to the non-separated group. Family separation predicted higher post-traumatic stress and depression symptoms, but not disability, after controlling for potentially traumatic event exposure, age and sex. Path analyses revealed distinct indirect effects for separated and non-separated groups. Principally, higher collectivistic self-identity was associated with elevated post-traumatic stress, depression and disability symptoms via social-related post-migration living difficulties such as isolation and loneliness in the separated group; whereas collectivism was linked with increased depression symptoms via economic-related post-migration living difficulties in the non-separated group. CONCLUSION These findings indicate that family separation powerfully influences mental health outcomes, but that its effect may be mediated by the type of post-migration stress experienced in the settlement environment and culturally bound differences in how the sense of self is interconnected with family.
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Affiliation(s)
| | - Yulisha Byrow
- School of Psychology, UNSW Sydney, Sydney, NSW, Australia
| | | | - Vicki Mau
- Australian Red Cross, North Melbourne, VIC, Australia
| | - Nicole Batch
- Australian Red Cross, North Melbourne, VIC, Australia
| | - Tadgh McMahon
- Settlement Services International, Ashfield, NSW, Australia
| | - Richard Bryant
- School of Psychology, UNSW Sydney, Sydney, NSW, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Liddell BJ, O'Donnell M, Bryant RA, Murphy S, Byrow Y, Mau V, McMahon T, Benson G, Nickerson A. The association between COVID-19 related stressors and mental health in refugees living in Australia. Eur J Psychotraumatol 2021; 12:1947564. [PMID: 34434532 PMCID: PMC8382014 DOI: 10.1080/20008198.2021.1947564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Refugees may be particularly vulnerable to the adverse effects of the COVID-19 pandemic on mental health due to their traumatic pasts and the challenges of the postmigration environment. OBJECTIVE To evaluate the prevalence of COVID-19 related stressors and their relationship to key mental health and functioning outcomes in a resettled refugee sample. METHOD N = 656 refugees and asylum seekers living in Australia completed a survey in June 2020 to index their mental health (posttraumatic stress disorder (PTSD), depression, health anxiety and disability) and COVID-19 experiences. The relationship between COVID-19 stressors and mental health was examined using a series of hierarchical linear regression models while controlling for other key demographic factors. RESULTS Refugees' most prevalent stressors related to worries of being infected by COVID-19 or the risk COVID-19 posed to others, which predicted health anxiety and PTSD. Social-related difficulties predicted depression and disability symptoms. Accessing and trusting information from authorities were the least prevalent stressors and were not significantly associated with mental health outcomes; neither was accessing basic supplies and financial support. Fears relating to the future such as concerns about visa application processes predicted health anxiety and disability. Crucially, the strongest predictor of all mental health outcomes was COVID-19 serving as a reminder of difficult past events. CONCLUSIONS Refugees may be uniquely affected by COVID-19 because the pandemic serves as a reminder of their past conflict and persecution trauma. It is critical that mental health strategies accommodate the specific needs of refugees during the COVID-19 pandemic.
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Affiliation(s)
| | | | | | | | - Yulisha Byrow
- School of Psychology, UNSW Sydney, Sydney, Australia
| | - Vicki Mau
- Australian Red Cross, North Melbourne, Australia
| | - Tadgh McMahon
- Settlement Services International, Ashfield, Australia
| | - Greg Benson
- Settlement Services International, Ashfield, Australia
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16
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Abstract
BACKGROUND Refugees may be especially vulnerable to the adverse effects of COVID-19. Therefore it is critical that refugee communities are supported to access COVID-19 vaccines and for public health responses to address vaccine hesitancy. OBJECTIVE To investigate the key demographic factors, barriers and attitudes associated with vaccine hesitancy in a community sample of refugees. METHOD Participants in the Refugee Adjustment Study, a cohort of refugees living in Australia, were invited to complete a survey about their COVID-19 vaccine intentions, barriers to access and attitudes relating to the vaccine. RESULTS Of the 516 participants, 88% were unvaccinated and 28.1% were classed as vaccine hesitant. Key predictors of vaccine hesitancy were younger age, information and trust barriers, lower logistical barriers, and attitudes relating to low control and risk posed by COVID-19. CONCLUSIONS Findings suggest that public health strategies need to address trust, control and risk perception attitudes to increase COVID-19 vaccine uptake in resettled refugee communities.
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Affiliation(s)
| | | | - Vicki Mau
- Australian Red Cross, North Melbourne, Australia
| | | | - Meaghan O'Donnell
- Phoenix Australia, Phoenix Australia, University of Melbourne, Carlton, Australia
| | - Tadgh McMahon
- Settlement Services International, Ashfield, Australia.,Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
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17
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Nickerson A, Byrow Y, Pajak R, McMahon T, Bryant RA, Christensen H, Liddell BJ. 'Tell Your Story': a randomized controlled trial of an online intervention to reduce mental health stigma and increase help-seeking in refugee men with posttraumatic stress. Psychol Med 2020; 50:781-792. [PMID: 30973115 DOI: 10.1017/s0033291719000606] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Refugees report elevated rates of posttraumatic stress disorder (PTSD), but are relatively unlikely to seek help for their symptoms. Mental health stigma is a key barrier to help-seeking amongst refugees. We evaluated the efficacy of an online intervention in reducing self-stigma and increasing help-seeking in refugee men. METHODS Participants were 103 refugee men with PTSD symptoms from Arabic, Farsi or Tamil-speaking backgrounds who were randomly assigned to either receive an 11-module online stigma reduction intervention specifically designed for refugees ('Tell Your Story', TYS) or to a wait-list control (WLC) group. Participants completed online assessments of self-stigma for PTSD and help-seeking, and help-seeking intentions and behaviors at baseline, post-intervention, and at a 1 month follow-up. RESULTS Intent-to-treat analyses indicated that, compared to the WLC, TYS resulted in significantly smaller increases in self-stigma for seeking help from post-treatment to follow-up (d = 0.42, p = 0.008). Further, participants in the TYS conditions showed greater help-seeking behavior from new sources at follow-up (B = 0.69, 95% CI 0.19-1.18, p = 0.007) than those in the WLC. The WLC showed significantly greater increases in help-seeking intentions from post-intervention to follow-up (d = 0.27, p = 0.027), relative to the TYS group. CONCLUSIONS This is the first investigation of a mental health stigma reduction program specifically designed for refugees. Findings suggest that evidence-based stigma reduction strategies are beneficial in targeting self-stigma related to help-seeking and increasing help-seeking amongst refugees. These results indicate that online interventions focusing on social contact may be a promising avenue for removing barriers to accessing help for mental health symptoms in traumatized refugees.
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Affiliation(s)
- Angela Nickerson
- School of Psychology, University of New South Wales, SydneyNSW2052, Australia
| | - Yulisha Byrow
- School of Psychology, University of New South Wales, SydneyNSW2052, Australia
| | - Rosanna Pajak
- School of Psychology, University of New South Wales, SydneyNSW2052, Australia
| | - Tadgh McMahon
- Settlement Services International, Sydney, NSWAustralia
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, SydneyNSW2052, Australia
| | - Helen Christensen
- Black Dog Institute, School of Psychiatry, University of New South Wales, SydneyNSW2052, Australia
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, SydneyNSW2052, Australia
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18
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Newman VE, Liddell BJ, Beesley T, Most SB. Failures of executive function when at a height: Negative height-related appraisals are associated with poor executive function during a virtual height stressor. Acta Psychol (Amst) 2020; 203:102984. [PMID: 31887635 DOI: 10.1016/j.actpsy.2019.102984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 12/31/2022] Open
Abstract
It is difficult to maintain cognitive functioning in threatening contexts, even when it is imperative to do so. Research indicates that precarious situations can impair subsequent executive functioning, depending on whether they are appraised as threatening. Here, we used virtual reality to place participants at ground level or at a virtual height in order to examine the impact of a threat-related context on concurrent executive function and whether this relationship was modulated by negative appraisals of heights. Executive function was assessed via the Go/NoGo and N-Back tasks, indexing response inhibition and working memory updating respectively. Participants with negative appraisals of heights exhibited impaired executive function on both tasks when performing at a virtual height (i.e., a threat-related context) but not at ground-level, demonstrating the importance of considering the cognitive consequences of individual differences in negative interpretations of emotionally-evocative situations. We suggest that a virtual reality approach holds practical benefits for understanding how individuals are able to maintain cognitive ability when embedded within threatening situations.
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19
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Liddell BJ, Nickerson A, Felmingham KL, Malhi GS, Cheung J, Den M, Askovic M, Coello M, Aroche J, Bryant RA. Complex Posttraumatic Stress Disorder Symptom Profiles in Traumatized Refugees. J Trauma Stress 2019; 32:822-832. [PMID: 31648412 DOI: 10.1002/jts.22453] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 11/11/2022]
Abstract
Although it is well documented that exposure to severe, cumulative trauma and postdisplacement stress increases the risk for posttraumatic stress symptom disorder (PTSD), less is known about the representation and predictors of complex PTSD (CPTSD) symptoms in refugee populations. We examined PTSD and CPTSD symptom profiles (co-occurring PTSD and disturbances in self-organization [DSO] symptoms) and their premigration, postmigration, and demographic predictors, using latent class analysis (LCA), in a cohort of 112 refugees resettled in Australia. The LCA identified a four-factor model as the best fit to the data, comprising classes categorized as: (a) CPTSD, exhibiting high levels of PTSD and DSO symptoms (29.5%); (b) PTSD only (23.5%); (c) high affective dysregulation (AD) symptoms (31.9%); and (d) low PTSD and DSO symptoms (15.1%). Membership in the CPTSD and PTSD classes was specifically associated with cumulative traumatization, CPTSD OR = 1.56, 95% CI [1.15, 2.12], and PTSD OR = 1.64, 95% CI [1.15, 2.34]; and female gender, CPTSD OR = 14.18, 95% CI [1.66, 121.29], and PTSD OR = 16.84, 95% CI [1.78, 159.2], relative to the low-symptom class. Moreover, CPTSD and AD class membership was significantly predicted by insecure visa status, CPTSD OR = 7.53, 95% CI [1.26, 45.08], and AD OR = 7.19, 95% CI [1.23, 42.05]. These findings are consistent with the ICD-11 model of CPTSD and highlight the contributions of cumulative trauma to CPTSD and PTSD profiles as well as of contextual stress from visa uncertainty to DSO symptom profiles in refugee cohorts, particularly those characterized by AD.
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Affiliation(s)
- Belinda J Liddell
- School of Psychology, University of New South Wales-Sydney, Sydney, Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales-Sydney, Sydney, Australia
| | - Kim L Felmingham
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Gin S Malhi
- Department of Psychiatry, Sydney Medical School-Northern, University of Sydney, Sydney, Australia
| | - Jessica Cheung
- School of Psychology, University of New South Wales-Sydney, Sydney, Australia
| | - Miriam Den
- School of Psychology, University of New South Wales-Sydney, Sydney, Australia
| | - Mirjana Askovic
- NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, Australia
| | - Mariano Coello
- NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, Australia
| | - Jorge Aroche
- NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales-Sydney, Sydney, Australia
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20
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Liddell BJ, Nickerson A, Sartor L, Ivancic L, Bryant RA. Corrigendum to "The generational gap: Mental disorder prevalence and disability amongst first and second generation immigrants in Australia" [J. Psychiatr Res. 83 (2016):103-111]. J Psychiatr Res 2019; 118:7. [PMID: 31442791 DOI: 10.1016/j.jpsychires.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Lauren Sartor
- School of Psychology, University of New South Wales, Australia
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21
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Nickerson A, Liddell BJ, Keegan D, Edwards B, Felmingham KL, Forbes D, Hadzi-Pavlovic D, McFarlane AC, O'Donnell M, Silove D, Steel Z, van Hooff M, Bryant RA. Longitudinal association between trust, psychological symptoms and community engagement in resettled refugees. Psychol Med 2019; 49:1661-1669. [PMID: 30160232 DOI: 10.1017/s0033291718002246] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The mental health and social functioning of millions of forcibly displaced individuals worldwide represents a key public health priority for host governments. This is the first longitudinal study with a representative sample to examine the impact of interpersonal trust and psychological symptoms on community engagement in refugees. METHODS Participants were 1894 resettled refugees, assessed within 6 months of receiving a permanent visa in Australia, and again 2-3 years later. Variables measured included post-traumatic stress disorder symptoms, depression/anxiety symptoms, interpersonal trust and engagement with refugees' own and other communities. RESULTS A multilevel path analysis was conducted, with the final model evidencing good fit (Comparative Fit Index = 0.97, Tucker-Lewis Index = 0.89, Root Mean Square Error of Approximation = 0.05, Standardized Root-Mean-Square-Residual = 0.05). Findings revealed that high levels of depression symptoms were associated with lower subsequent engagement with refugees' own communities. In contrast, low levels of interpersonal trust were associated with lower engagement with the host community over the same timeframe. CONCLUSIONS Findings point to differential pathways to social engagement in the medium-term post-resettlement. Results indicate that depression symptoms are linked to reduced engagement with one's own community, while interpersonal trust is implicated in engagement with the broader community in the host country. These findings have potentially important implications for policy and clinical practice, suggesting that clinical and support services should target psychological symptoms and interpersonal processes when fostering positive adaptation in resettled refugees.
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Affiliation(s)
- Angela Nickerson
- School of Psychology,University of New South Wales,Sydney,Australia
| | | | | | - Ben Edwards
- Centre for Social Research, The Australian National University,Canberra,Australia
| | - Kim L Felmingham
- School of Psychological Sciences, University of Melbourne,Melbourne,Victoria,Australia
| | - David Forbes
- Department of Psychiatry,University of Melbourne,Parkville,Victoria,Australia
| | | | - Alexander C McFarlane
- The Centre for Traumatic Stress, University of Adelaide,Adelaide,SouthAustralia,Australia
| | - Meaghan O'Donnell
- Department of Psychiatry,University of Melbourne,Parkville,Victoria,Australia
| | - Derrick Silove
- School of Psychiatry,University of New South Wales,Sydney,Australia
| | - Zachary Steel
- School of Psychiatry,University of New South Wales,Sydney,Australia
| | - Miranda van Hooff
- The Centre for Traumatic Stress, University of Adelaide,Adelaide,SouthAustralia,Australia
| | - Richard A Bryant
- School of Psychology,University of New South Wales,Sydney,Australia
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22
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Abstract
Cultural differences exist in the use of emotion regulation (ER) strategies, but the focus to date has been on intrapersonal ER strategies such as cognitive reappraisal. An emerging literature highlights the importance of interpersonal ER, which utilizes social cues to facilitate the regulation of emotional states. In cultures that place high value on social interconnectedness as integral to their collectivistic self-construal, including East Asian cultures, interpersonal ER strategies may be particularly effective in reducing negative affect but this has not been previously tested. In this study, two groups comprising East Asian (n = 48) and Western European (n = 38) participants were randomly assigned to receive a priming narration depicting the use of either interpersonal (e.g., social modeling, perspective taking) or intrapersonal (e.g., cognitive reappraisal) ER strategies during a stressful experience. They were then instructed to utilize similar ER strategies in an emotion reactivity task during which they viewed high arousing negative pictorial stimuli while their heart rate (HR), heart rate variability (high frequency power - HF-HRV) and subjective affective states were measured. First we found that the East Asian group reported higher use of interpersonal ER strategies of social modeling and perspective taking in daily life. During the experimental interpersonal prime exposure, the East Asian group showed elevated HF-HRV (relative to baseline) compared to the Western European group, indicating more adaptive ER, but this pattern was not sustained during the reactivity or recovery phases. Instead, the East Asian group demonstrated increased HF-HRV and decreased HR across both prime conditions. The East Asian group also showed greater decreases in positive affect across the course of the experiment. Furthermore, individual differences in social modeling and individualistic self-construal moderated the effect of the ER prime in the East Asian group at trend levels, and main effects for perspective taking and reappraisal were observed in the Western European group. The findings support the notion that engaging in interpersonal ER strategies may be more beneficial for East Asian groups when immediately exposed to a stressful situation, as these strategies are congruent with cultural context and preferences, but our priming methodology may have limited the longer-term benefits.
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Affiliation(s)
- Belinda J. Liddell
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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23
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Toumbelekis M, Liddell BJ, Bryant RA. Thinking of attachment figures blocks differential fear conditioning. Soc Cogn Affect Neurosci 2019; 13:989-994. [PMID: 30137625 PMCID: PMC6137313 DOI: 10.1093/scan/nsy065] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 08/02/2018] [Indexed: 11/13/2022] Open
Abstract
Thinking of attachment figures can potentially impact acquisition and extinction of fear memories. In this study, 50 participants underwent a fear conditioning and extinction paradigm. Half the participants thought about a supportive attachment figure and half thought about a non-attachment positive experience prior to the fear conditioning. All participants then underwent a differential fear conditioning and fear extinction paradigm, and returned 2 days later for an extinction recall task. Fear-potentiated startle and subjective expectancy of shock ratings were measured as the primary indicators of fear learning across trials. The attachment prime significantly reduced the acquisition of fear-potentiated startle, and this lower level of fear was maintained at the extinction recall task. These results demonstrate that attachment primes can modulate the acquisition of conditioned fear. These findings provide preliminary evidence for the protective nature of attachment relationships at times that are characterized by fear learning.
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24
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Spiller TR, Liddell BJ, Schick M, Morina N, Schnyder U, Pfaltz M, Bryant RA, Nickerson A. Emotional Reactivity, Emotion Regulation Capacity, and Posttraumatic Stress Disorder in Traumatized Refugees: An Experimental Investigation. J Trauma Stress 2019; 32:32-41. [PMID: 30729584 DOI: 10.1002/jts.22371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 10/02/2018] [Accepted: 10/06/2018] [Indexed: 11/08/2022]
Abstract
Refugees who suffer from posttraumatic stress disorder (PTSD) often react with strong emotions when confronted with trauma reminders. In this study, we aimed to investigate the associations between low emotion regulation capacity (as indexed by low heart rate variability [HRV]), probable PTSD diagnosis, and fear and anger reaction and recovery to trauma-related stimuli. Participants were 81 trauma-exposed refugees (probable PTSD, n = 23; trauma-exposed controls, n = 58). The experiment comprised three 5-min phases: a resting phase (baseline); an exposition phase, during which participants were exposed to trauma-related images (stimulus); and another resting phase (recovery). We assessed HRV at baseline, and fear and anger were rated at the end of each phase. Linear mixed model analyses were used to investigate the associations between baseline HRV and probable DSM-5 PTSD diagnosis in influencing anger and fear responses both immediately after viewing trauma-related stimuli and at the end of the recovery phase. Compared to controls, participants with probable PTSD showed a greater increase in fear from baseline to stimulus presentation, d = 0.606. Compared to participants with low emotion regulation capacity, participants with high emotion regulation capacity showed a smaller reduction in anger from stimulus presentation to recovery, d = 0.548. Our findings indicated that following exposure to trauma-related stimuli, probable PTSD diagnosis predicted increased fear reactivity, and low emotion regulation capacity predicted decreased anger recovery. Impaired anger recovery following trauma reminders in the context of low emotion regulation capacity might contribute to the increased levels of anger found in postconflict samples.
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Affiliation(s)
- Tobias R Spiller
- University of Zurich, University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Switzerland
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Matthis Schick
- University of Zurich, University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Switzerland
| | - Naser Morina
- University of Zurich, University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Switzerland
| | - Ulrich Schnyder
- University of Zurich, University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Switzerland
| | - Monique Pfaltz
- University of Zurich, University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Switzerland
| | - Richard A Bryant
- 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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25
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Nickerson A, Byrow Y, O'Donnell M, Mau V, McMahon T, Pajak R, Li S, Hamilton A, Minihan S, Liu C, Bryant RA, Berle D, Liddell BJ. The association between visa insecurity and mental health, disability and social engagement in refugees living in Australia. Eur J Psychotraumatol 2019; 10:1688129. [PMID: 32002133 PMCID: PMC6968544 DOI: 10.1080/20008198.2019.1688129] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/29/2022] Open
Abstract
Background: The vast majority of the world's refugees and people seeking asylum live in a state of sustained displacement. Little is known, however, about the mental health impact of prolonged insecurity. Objective: This study aimed to investigate the association between insecure visa status and mental health, suicidality, disability and social engagement in a sample of refugees and asylum-seekers living in Australia Method: Participants were 1,085 refugees with secure (i.e. permanent residency or Australian citizenship, n = 826, 76.1%) and insecure (i.e. asylum-seeker claim, bridging visa, temporary visa, n = 259, 23.9%) visa status who had arrived in Australia since January 2011, and were from Arabic, Farsi, Tamil or English-speaking backgrounds. Participants completed an online survey assessing pre- and post-migration experiences, mental health, disability and social engagement. Results: Results indicated that, after controlling for background factors, refugees with insecure visas had significantly greater PTSD symptoms, depression symptoms, thoughts of being better off dead and suicidal intent compared to those with secure visas. There were no group differences in disability. Refugees with insecure visas received support from significantly more groups in the Australian community than those with secure visas. Further, refugees with insecure visa status who had low group membership showed greater depression symptoms and suicidal intent than those with secure visa status who had low group membership. Conclusion: Findings highlight the negative mental health consequences of living in a state of protracted uncertainty for refugees and people seeking asylum, and the key role of social engagement in influencing mental health amongst insecure visa holders. Results also underscore the importance of designing and implementing policies and services that facilitate improved mental health for those with visa insecurity.
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Affiliation(s)
| | - Yulisha Byrow
- School of Psychology, UNSW Sydney, Sydney, Australia
| | | | - Vicki Mau
- Australian Red Cross, North Melbourne, Australia
| | - Tadgh McMahon
- Settlement Services International, Ashfield, Australia
| | - Rosanna Pajak
- School of Psychology, UNSW Sydney, Sydney, Australia
| | - Susan Li
- School of Psychology, UNSW Sydney, Sydney, Australia
| | | | | | - Candy Liu
- School of Psychology, UNSW Sydney, Sydney, Australia
| | | | - David Berle
- School of Psychology, University of Technology Sydney, Sydney, Australia
| | - Belinda J Liddell
- School of Psychology, UNSW Sydney, Sydney, Australia.,Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Abstract
Attachment systems facilitate coping with stress, with previous studies demonstrating attachment figures diminishing subjective, behavioral and neural responses to social pain. Yet little is known about the physiological mechanisms governing this benefit in the context of social exclusion. This study investigated the impact of attachment (vs non-attachment) priming on affective and cardiovascular responses to social exclusion induced by the computerized “Cyberball” ball-tossing game, and the moderating influence of individual differences in attachment style, rejection sensitivity and self-construal. No significant change in high frequency heart rate variability (HF-HRV)–an index of parasympathetic activity and cardiovagal balance–was observed across the time course in the attachment priming condition, whereas the non-attachment condition showed significant fluctuation in HF-HRV–increasing during Cyberball and decreasing relative to baseline during recovery. Moreover, the benefit afforded by attachment priming on was enhanced amongst participants with lower rejection sensitivity and higher collectivistic self-construal, and those with higher anxious attachment style in the non-attachment prime group showed a trend towards increased HF-HRV during the Cyberball. Results are consistent with Social Baseline Theory, which argues that social proximity–particularly from attachment figures–protects against the metabolic costs associated with strong reactions to stress, including the preservation of cardiovagal homeostasis in this instance. Social attachments may provide an important mechanism to increase adaptive responding to the distressing experience of social exclusion.
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Specker P, Liddell BJ, Byrow Y, Bryant RA, Nickerson A. A factor analytic investigation of DSM-5 PTSD symptoms in a culturally diverse sample of refugees resettled in Australia. Confl Health 2018; 12:26. [PMID: 29796081 PMCID: PMC5964709 DOI: 10.1186/s13031-018-0155-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 03/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background Refugees and asylum-seekers are often exposed to multiple types of potentially traumatic events (PTEs) and report elevated rates of psychological disorders, including posttraumatic stress disorder (PTSD). Considering this, refugee populations merit continued research in the field of traumatic stress to better understand the psychological impact of these experiences. The symptom structure of PTSD underwent a major revision in the recent formulation in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and this reformulation has yet to be comprehensively investigated in the context of PTSD arising from traumatic events experienced by refugees. The current study assessed the construct validity of the DSM-5 PTSD structure in a refugee sample from a variety of cultural backgrounds alongside four alternate models commonly identified in western populations, namely the four-factor Dysphoria model, the five-factor Dysphoric Arousal model, and the six-factor Anhedonia and Externalising Behaviours models. Methods A total of 246 refugees settled in Australia were assessed using the Harvard Trauma Questionnaire, to measure exposure to potentially traumatic events (PTEs), and the Posttraumatic Diagnostic Scale, to assess symptoms of PTSD based on DSM-5 criteria. All measures were translated into Arabic, Farsi or Tamil using rigorous translation procedures, or provided in English. Results Findings from five confirmatory factor analyses (CFAs) revealed that all models demonstrated acceptable model fit. However, an examination of relative fit revealed that the DSM-5 model provided the poorest fit overall for our sample. Instead, we found preliminary evidence in support of the six-factor Anhedonia model, comprising the symptom clusters of re-experiencing, avoidance, negative affect, anhedonia, dysphoric arousal and anxious arousal, as the superior model for our data. Conclusions Our findings offer preliminary support for the applicability of the Anhedonia model to a culturally diverse refugee sample, and contribute to a growing body of studies which indicate that the DSM-5 model may not best represent the symptom structure of PTSD found across non-western conflict-affected populations.
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Affiliation(s)
- Philippa Specker
- School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia
| | - Yulisha Byrow
- School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia
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Battaglini E, Liddell BJ, Das P, Malhi GS, Felmingham K, Bryant RA. An investigation of potential neural correlates of intrusive retrieval of distressing memories. J Behav Ther Exp Psychiatry 2018; 58:60-67. [PMID: 28886406 DOI: 10.1016/j.jbtep.2017.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 08/03/2017] [Accepted: 08/12/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite the prevalence of intrusive memories across psychological disorders, little is known about the neural networks that underpin this form of memory. This study used functional magnetic resonance imaging (fMRI) to identify neural circuits associated with the retrieval of intrusive memories. METHODS Participants with moderate levels of anxiety (N = 30) underwent a cold pressor task to induce a physiological stress response, after which they viewed 10 neutral and 10 negative film clips. In a method designed to induce intrusive memories, participants then completed an fMRI scan in which they viewed short (2 s) depictions of neutral components from the original film clips. RESULTS There were no significant differences in activations during intrusion and non-intrusion responses. Exploratory analyses comparing intrusive responses to neutral stimuli found the insula, inferior frontal gyrus, precuneus, right cerebellum and bilateral supplementary motor area were uniquely activated during experience of intrusions (compared to the neutral cue baseline), whereas no significant activations were in response to negative scenes that did not trigger intrusions. LIMITATIONS This study did not compare the different neural processes implicated in intrusive and intentional emotional memories. The limited intrusions that could be elicited in the scanning environment restricted the number of trials that could be employed. CONCLUSIONS Although no differences in neural activations were observed between intrusive and non-intrusive responses, the observation of precuneus involvement is consistent with models that propose that intrusive memories are impacted by the extent to which there is contextual integration of the relevant memories.
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Liddell BJ, Nickerson A, Bryant RA. Clinical science and torture survivors' rights to rehabilitation. Lancet Psychiatry 2018; 5:101-103. [PMID: 29102313 DOI: 10.1016/s2215-0366(17)30332-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 10/18/2022]
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Liddell BJ, Felmingham KL, Das P, Whitford TJ, Malhi GS, Battaglini E, Bryant RA. Self-construal differences in neural responses to negative social cues. Biol Psychol 2017; 129:62-72. [PMID: 28782584 DOI: 10.1016/j.biopsycho.2017.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 07/27/2017] [Accepted: 07/30/2017] [Indexed: 11/29/2022]
Abstract
Cultures differ substantially in representations of the self. Whereas individualistic cultural groups emphasize an independent self, reflected in processing biases towards centralized salient objects, collectivistic cultures are oriented towards an interdependent self, attending to contextual associations between visual cues. It is unknown how these perceptual biases may affect brain activity in response to negative social cues. Moreover, while some studies have shown that individual differences in self-construal moderate cultural group comparisons, few have examined self-construal differences separate to culture. To investigate these issues, a final sample of a group of healthy participants high in trait levels of collectivistic self-construal (n=16) and individualistic self-construal (n=19), regardless of cultural background, completed a negative social cue evaluation task designed to engage face/object vs context-specific neural processes whilst undergoing fMRI scanning. Between-group analyses revealed that the collectivistic group exclusively engaged the parahippocampal gyrus (parahippocampal place area) - a region critical to contextual integration - during negative face processing - suggesting compensatory activations when contextual information was missing. The collectivist group also displayed enhanced negative context dependent brain activity involving the left superior occipital gyrus/cuneus and right anterior insula. By contrast, the individualistic group did not engage object or localized face processing regions as predicted, but rather demonstrated heightened appraisal and self-referential activations in medial prefrontal and temporoparietal regions to negative contexts - again suggesting compensatory processes when focal cues were absent. While individualists also appeared more sensitive to negative faces in the scenes, activating the right middle cingulate gyrus, dorsal prefrontal and parietal activations, this activity was observed relative to the scrambled baseline, and given that prefrontal and occipital regions were also engaged to neutral stimuli, may suggest an individualistic pattern to processing all social cues more generally. These findings suggest that individual differences in self-construal may be an important organizing framework facilitating perceptual processes to emotionally salient social cues, beyond the boundary of cultural group comparisons.
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Affiliation(s)
| | - Kim L Felmingham
- School of Psychological Sciences, University of Melbourne, Victoria, 3052, Australia
| | - Pritha Das
- Department of Psychiatry, Sydney Medical School - Northern, University of Sydney, Level 3, Main Building, Royal North Shore Hospital, St. Leonard's, New South Wales, 2065 Australia
| | | | - Gin S Malhi
- Department of Psychiatry, Sydney Medical School - Northern, University of Sydney, Level 3, Main Building, Royal North Shore Hospital, St. Leonard's, New South Wales, 2065 Australia
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Doolan EL, Bryant RA, Liddell BJ, Nickerson A. The conceptualization of emotion regulation difficulties, and its association with posttraumatic stress symptoms in traumatized refugees. J Anxiety Disord 2017; 50:7-14. [PMID: 28505466 DOI: 10.1016/j.janxdis.2017.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 02/20/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
This study investigated the conceptualization of emotion regulation difficulties in a sample of refugees with varying levels of posttraumatic stress (PTS), and examined whether specific emotion regulation difficulties were associated with PTS severity. Refugees were administered an abbreviated version of the Difficulties in Emotion Regulation Scale, the PTSD Symptom Scale - Interview Version, and the Harvard Trauma Questionnaire. Confirmatory Factor Analysis was used to examine model fit for the 6-factor model originally proposed by the developers of the DERS and the more recently proposed 5-factor model that excludes the awareness subscale. Both models displayed adequate fit. After controlling for age, gender, time in Australia, and trauma exposure, the clarity and strategies subscales were significantly associated with PTS severity. The association between impaired emotional clarity and reduced agency related to accessing regulation strategies and PTS severity in this refugee sample highlights the need for further research to assess interventions that target these disruptions in refugees.
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Liddell BJ, Nickerson A, Sartor L, Ivancic L, Bryant RA. The generational gap: Mental disorder prevalence and disability amongst first and second generation immigrants in Australia. J Psychiatr Res 2016; 83:103-111. [PMID: 27585424 DOI: 10.1016/j.jpsychires.2016.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/18/2016] [Accepted: 08/18/2016] [Indexed: 11/18/2022]
Abstract
Despite unprecedented numbers of migrants internationally, little is known about the mental health needs of immigrant groups residing in common countries of resettlement. The majority of studies support the 'healthy migrant hypothesis', but few studies have examined: 1) shifts in prevalence patterns across generations; 2) how prevalence relates to disability in immigrant groups. Our study examined the prevalence of common mental disorders and disability in first and second generation migrants to Australia. Twelve-month and lifetime prevalence rates of affective, anxiety, and substance use disorders were obtained from the Australian National Survey of Mental Health and Wellbeing (N = 8841). First generation immigrants (born overseas) and second generation immigrants (both parents overseas) from non-English and English speaking backgrounds were compared to an Australian-born cohort. Disability was indexed by days out of role and the WHO Disability Assessment Schedule (WHODAS12). First generation immigrants with non-English speaking (1G-NE) backgrounds evidenced reduced prevalence of common mental disorders relative to the Australian-born population (adjusted odds ratio 0.5 [95% CI 0.38-0.66]). This lower prevalence was not observed in second generation immigrant cohorts. While overall levels of disability were equal between all groups (p > 0.05), mental health-related disability was elevated in the 1G-NE group relative to the Australian-born group (p = 0.012). The findings challenge the overarching notion of the "healthy migrant" and suggest a dissociation between reduced prevalence and elevated mental health-related disability amongst first generation immigrants with non-English speaking backgrounds. These findings highlight the heterogeneous psychiatric needs of first and second generation immigrants.
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Affiliation(s)
| | | | - Lauren Sartor
- School of Psychology, University of New South Wales, Australia
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Liddell BJ, Jobson L. The impact of cultural differences in self-representation on the neural substrates of posttraumatic stress disorder. Eur J Psychotraumatol 2016; 7:30464. [PMID: 27302635 PMCID: PMC4908066 DOI: 10.3402/ejpt.v7.30464] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 05/12/2016] [Accepted: 05/14/2016] [Indexed: 11/23/2022] Open
Abstract
A significant body of literature documents the neural mechanisms involved in the development and maintenance of posttraumatic stress disorder (PTSD). However, there is very little empirical work considering the influence of culture on these underlying mechanisms. Accumulating cultural neuroscience research clearly indicates that cultural differences in self-representation modulate many of the same neural processes proposed to be aberrant in PTSD. The objective of this review paper is to consider how culture may impact on the neural mechanisms underlying PTSD. We first outline five key affective and cognitive functions and their underlying neural correlates that have been identified as being disrupted in PTSD: (1) fear dysregulation; (2) attentional biases to threat; (3) emotion and autobiographical memory; (4) self-referential processing; and (5) attachment and interpersonal processing. Second, we consider prominent cultural theories and review the empirical research that has demonstrated the influence of cultural variations in self-representation on the neural substrates of these same five affective and cognitive functions. Finally, we propose a conceptual model that suggests that these five processes have major relevance to considering how culture may influence the neural processes underpinning PTSD.
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Affiliation(s)
- Belinda J Liddell
- School of Psychology, University of New South Wales Australia, Sydney, Australia;
| | - Laura Jobson
- School of Psychological Sciences, Monash University, Clayton, Australia
- Monash Institute of Cognitive and Clinical Neurosciences, Clayton, Australia
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Liddell BJ, Kemp AH, Steel Z, Nickerson A, Bryant RA, Tam N, Tay AK, Silove D. Heart rate variability and the relationship between trauma exposure age, and psychopathology in a post-conflict setting. BMC Psychiatry 2016; 16:133. [PMID: 27165346 PMCID: PMC4862083 DOI: 10.1186/s12888-016-0850-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 05/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cumulative exposure to potentially traumatic events (PTEs) increases risk for mental distress in conflict-affected settings, but the psychophysiological mechanisms that mediate this dose-response relationship are unknown. We investigated diminished heart rate variability (HRV) - an index of vagus nerve function and a robust predictor of emotion regulation capacity - as a vulnerability marker that potentially mediates the association between PTE exposure, age and symptoms of posttraumatic stress disorder (PTSD), psychological distress and aggressive behavior, in a community sample from Timor-Leste - a post-conflict country with a history of mass violence. METHOD Resting state heart rate data was recorded from 45 cases of PTSD, depression and intermittent explosive disorder (IED); and 29 non-case controls. RESULTS Resting HRV was significantly reduced in the combined case group compared with non-cases (p = .021; Cohen's d = 0.5). A significant mediation effect was also observed, whereby a sequence of increased age, reduced HRV and elevated PTSD symptoms mediated the association between PTE exposure and distress (B = .06, SE = .05, 95% CI = [.00-.217]) and aggression (B = .02, SE = .02, 95% CI = [.0003-.069])). CONCLUSION The findings demonstrate an association between diminished resting HRV and psychopathology. Moreover, age-related HRV reductions emerged as a potential psychophysiological mechanism that underlies enhanced vulnerability to distress and aggression following cumulative PTE exposure.
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Affiliation(s)
- Belinda J. Liddell
- The Psychiatry Research and Teaching Unit (PRTU), School of Psychiatry, University of New South Wales, Sydney, Australia ,School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia
| | - Andrew H. Kemp
- Discipline of Psychiatry, University of Sydney, Sydney, NSW Australia
| | - Zachary Steel
- The Psychiatry Research and Teaching Unit (PRTU), School of Psychiatry, University of New South Wales, Sydney, Australia ,St John of God, Richmond Hospital, North Richmond, NSW 2754 Australia ,Black Dog Institute, School of Psychiatry, University of New South Wales, NSW Sydney, Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia
| | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia
| | - Natalino Tam
- Academic Mental Health Unit, South Western Sydney Local Health District, Sydney, Australia
| | - Alvin Kuowei Tay
- The Psychiatry Research and Teaching Unit (PRTU), School of Psychiatry, University of New South Wales, Sydney, Australia ,Academic Mental Health Unit, South Western Sydney Local Health District, Sydney, Australia
| | - Derrick Silove
- The Psychiatry Research and Teaching Unit (PRTU), School of Psychiatry, University of New South Wales, Sydney, Australia ,Academic Mental Health Unit, South Western Sydney Local Health District, Sydney, Australia
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Liddell BJ, Das P, Battaglini E, Malhi GS, Felmingham KL, Whitford TJ, Bryant RA. Self-Orientation Modulates the Neural Correlates of Global and Local Processing. PLoS One 2015; 10:e0135453. [PMID: 26270820 PMCID: PMC4536227 DOI: 10.1371/journal.pone.0135453] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 07/22/2015] [Indexed: 11/18/2022] Open
Abstract
Differences in self-orientation (or "self-construal") may affect how the visual environment is attended, but the neural and cultural mechanisms that drive this remain unclear. Behavioral studies have demonstrated that people from Western backgrounds with predominant individualistic values are perceptually biased towards local-level information; whereas people from non-Western backgrounds that support collectivist values are preferentially focused on contextual and global-level information. In this study, we compared two groups differing in predominant individualistic (N = 15) vs collectivistic (N = 15) self-orientation. Participants completed a global/local perceptual conflict task whilst undergoing functional Magnetic Resonance Imaging (fMRI) scanning. When participants high in individualistic values attended to the global level (ignoring the local level), greater activity was observed in the frontoparietal and cingulo-opercular networks that underpin attentional control, compared to the match (congruent) baseline. Participants high in collectivistic values activated similar attentional control networks o only when directly compared with global processing. This suggests that global interference was stronger than local interference in the conflict task in the collectivistic group. Both groups showed increased activity in dorsolateral prefrontal regions involved in resolving perceptual conflict during heightened distractor interference. The findings suggest that self-orientation may play an important role in driving attention networks to facilitate interaction with the visual environment.
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Affiliation(s)
- Belinda J. Liddell
- School of Psychology, UNSW Australia, Sydney, New South Wales, NSW, 2052, Australia
- * E-mail:
| | - Pritha Das
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonard’s, NSW, 2065, Australia
- ARCHI, Sydney Medical School Northern, University of Sydney, Sydney, NSW, 2006, Australia
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonard’s, NSW, 2065, Australia
| | - Eva Battaglini
- School of Psychology, UNSW Australia, Sydney, New South Wales, NSW, 2052, Australia
| | - Gin S. Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonard’s, NSW, 2065, Australia
- ARCHI, Sydney Medical School Northern, University of Sydney, Sydney, NSW, 2006, Australia
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonard’s, NSW, 2065, Australia
| | - Kim L. Felmingham
- School of Psychology, University of Tasmania, Tasmania, Hobart, TAS, 7001, Australia
| | - Thomas J. Whitford
- School of Psychology, UNSW Australia, Sydney, New South Wales, NSW, 2052, Australia
| | - Richard A. Bryant
- School of Psychology, UNSW Australia, Sydney, New South Wales, NSW, 2052, Australia
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Nickerson A, Liddell BJ, Maccallum F, Steel Z, Silove D, Bryant RA. Posttraumatic stress disorder and prolonged grief in refugees exposed to trauma and loss. BMC Psychiatry 2014; 14:106. [PMID: 24712883 PMCID: PMC3998219 DOI: 10.1186/1471-244x-14-106] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/31/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While a large proportion of conflict-affected populations have been dually exposed to trauma and loss, there is inadequate research identifying differential symptom profiles related to bereavement and trauma exposure in these groups. The objective of this study were to (1) determine whether there are distinct classes of posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD) symptoms in bereaved trauma survivors exposed to conflict and persecution, and (2) examine whether particular types of refugee experiences and stressors differentially predict symptom profiles. METHODS Participants were 248 Mandaean adult refugees who were assessed at an average of 4.3 years since entering Australia following persecution in Iraq. PTSD, PGD, trauma exposure, adjustment difficulties since relocation, and English proficiency were measured. Latent class analysis was used to elucidate symptom profiles of PTSD and PGD in this sample. RESULTS Latent class analysis revealed four classes of participants: a combined PTSD/PGD class (16%), a predominantly PTSD class (25%), a predominantly PGD class (16%), and a resilient class (43%). Whereas membership in the PTSD/PGD class was predicted by exposure to traumatic loss, those in the PGD class were more likely to have experienced adaptation difficulties since relocation, and individuals in the PTSD class were more likely to have experienced difficulties related to loss of culture and support. CONCLUSIONS This study provides evidence that specific symptom patterns emerge following exposure to mass trauma and loss. These profiles are associated with distinct types of traumatic experiences and post-migration living difficulties. These results have substantial public health implications for assessment and intervention following mass trauma.
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Affiliation(s)
- Angela Nickerson
- School of Psychology, University of New South Wales, Sydney NSW 2052, Australia.
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, Sydney NSW 2052, Australia
| | - Fiona Maccallum
- School of Psychology, University of New South Wales, Sydney NSW 2052, Australia
| | - Zachary Steel
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney NSW, 2052, Australia
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney NSW, 2052, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney NSW 2052, Australia
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Liddell BJ, Chey T, Silove D, Phan TTB, Giao NM, Steel Z. Patterns of risk for anxiety-depression amongst Vietnamese-immigrants: a comparison with source and host populations. BMC Psychiatry 2013; 13:329. [PMID: 24294940 PMCID: PMC3898370 DOI: 10.1186/1471-244x-13-329] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 11/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies suggest that immigrants have higher rates of anxiety-depression than compatriots in low-middle income countries and lower rates than populations in host high income countries. Elucidating the factors that underlie these stepwise variations in prevalence may throw new light on the pathogenesis of anxiety-depressive disorders globally. This study aimed to examine whether quantitative differences in exposure to, or the interaction between, risk factors account for these anxiety-depression prevalence differences amongst immigrant relative to source and host country populations. METHODS Multistage population mental health surveys were conducted in three groups: 1) a Vietnamese-immigrant sample settled in Australia (n = 1161); 2) a Vietnamese source country sample residing in the Mekong Delta region (n = 3039); 3) an Australian-born host country sample (n = 7964). Multivariable logistic regression analyses compared risk factors between the Vietnamese-immigrant group and: 1) the Mekong Delta Vietnamese; and 2) the Australian-born group. Twelve month anxiety-depression diagnoses were the main outcome measures, derived from the Composite International Diagnostic Interview (CIDI), supplemented by an indigenously derived measure - the Phan Vietnamese Psychiatric Scale (PVPS) in both Vietnamese groups. RESULTS The 12-month prevalence of anxiety-depression showed a stepwise increase across groups: Mekong Delta Vietnamese 4.8%; Vietnamese-immigrants 7.0%; Australian-born 10.2%. The two Vietnamese populations showed a similar risk profile with older age, exposure to potentially traumatic events (PTEs), multiple physical illnesses and substance use disorder (SUD) being associated with anxiety-depression, with the older Vietnamese-immigrants reporting greater exposure to these factors. The interaction between key risk factors differed fundamentally when comparing Vietnamese-immigrant and Australian-born samples. Age emerged as the major discriminator, with young Vietnamese-immigrants exhibiting particularly low rates of anxiety-depression. CONCLUSIONS The findings reported here suggest that core risk factors for anxiety-depression may be universal, but their patterning and interaction may differ according to country-of-origin. The study also highlights the importance of including both standard international and culturally-specific measures to index cross-cultural manifestations of common mental disorders.
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Affiliation(s)
- Belinda J Liddell
- Psychiatry Research and Teaching Unit (PRTU), School of Psychiatry, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Tien Chey
- Centre for Population Mental Health Research, Level 1, Mental Health Centre, Liverpool Hospital, Sydney, Australia
| | - Derrick Silove
- Psychiatry Research and Teaching Unit (PRTU), School of Psychiatry, University of New South Wales, Sydney, Australia
- Centre for Population Mental Health Research, Level 1, Mental Health Centre, Liverpool Hospital, Sydney, Australia
| | - Thuy Thi Bich Phan
- Psychiatry Research and Teaching Unit (PRTU), School of Psychiatry, University of New South Wales, Sydney, Australia
- Centre for Population Mental Health Research, Level 1, Mental Health Centre, Liverpool Hospital, Sydney, Australia
| | | | - Zachary Steel
- Psychiatry Research and Teaching Unit (PRTU), School of Psychiatry, University of New South Wales, Sydney, Australia
- Centre for Population Mental Health Research, Level 1, Mental Health Centre, Liverpool Hospital, Sydney, Australia
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Liddell BJ, Silove D, Tay K, Tam N, Nickerson A, Brooks R, Rees S, Zwi AB, Steel Z. Achieving convergence between a community-based measure of explosive anger and a clinical interview for intermittent explosive disorder in Timor-Leste. J Affect Disord 2013; 150:1242-6. [PMID: 23835102 DOI: 10.1016/j.jad.2013.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 06/06/2013] [Accepted: 06/06/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is growing research interest in understanding and analyzing explosive forms of anger. General epidemiological studies have focused on the DSM-IV category of Intermittent Explosive Disorder (IED), while refugee and post-conflict research have used culturally-based indices of explosive anger. The aim of this study was to test the convergence of a culturally-sensitive community measure of explosive anger with a structured clinical interview diagnosis of IED in Timor-Leste, a country with a history of significant mass violence and displacement. METHODS A double-blind clinical concordance study was conducted amongst a stratified community sample in post-conflict Timor-Leste (n=85) to compare a community measure of anger against the Structured Clinical Interview (SCID) module for IED. RESULTS Clinical concordance between the two measures was high: the area under the curve (AUC) index was 0.90 (95% CI: 0.83-0.98); sensitivity and specificity were 93.3% and 87.5% respectively. LIMITATIONS Response rates were modest due to the participant's time commitments. CONCLUSIONS It is possible to achieve convergence between culturally-sensitive measures of explosive anger and the DSM-IV construct of IED, allowing comparison of findings across settings and populations.
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Affiliation(s)
- Belinda J Liddell
- Psychiatry Research and Teaching Unit (PRTU), School of Psychiatry, University of New South Wales, NSW Australia; School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia.
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Williams LM, Whitford TJ, Flynn G, Wong W, Liddell BJ, Silverstein S, Galletly C, Harris AWF, Gordon E. General and social cognition in first episode schizophrenia: identification of separable factors and prediction of functional outcome using the IntegNeuro test battery. Schizophr Res 2008; 99:182-91. [PMID: 18053688 DOI: 10.1016/j.schres.2007.10.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Revised: 10/22/2007] [Accepted: 10/25/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE It is increasingly recognized that cognitive assessments, unlike symptom ratings, provide a reliable predictor of functional outcome in schizophrenia. This study evaluated the utility of the 'IntegNeuro' computerized test battery for assessing cognition in first episode schizophrenia. We determined the presence of separable factors of general and social cognition, their equivalence to the consensus domains identified by the NIMH MATRICS project, and their effectiveness in predicting real world functional outcomes. METHOD Fifty six first episode schizophrenia (FES) patients and 112 matched healthy controls were assessed on the touchscreen-based 'IntegNeuro' cognitive test battery and FES patients for social functioning (SOFAS) and quality of life (WHOQOL-BREF). RESULTS Principal components analysis identified i) six factors corresponding to MATRICS domains of general cognition ('Information Processing Speed', 'Verbal Recall', 'Working Memory Capacity', 'Sustained Attention/Vigilance', 'Verbal Processing', 'Executive Function'), ii) an 'Emotional Intelligence' factor corresponding to the MATRICS social cognition domain, and iii) an additional 'Sensori-Motor Function' factor of general cognition and 'Negativity' factor of social cognition. Patients showed impairments relative to controls across all factors, but especially for Working Memory Capacity, followed by Verbal Memory, Sustained Attention/Vigilance and Negativity. These factors strongly predicted poorer social functioning in FES, along with poorer quality of life in psychological, social, and health satisfaction facets. CONCLUSION The IntegNeuro battery has utility for assessing separable domains of general and social cognition in FES, which are predictive of real world outcomes. Thus, it may be appropriate for clinical application, including in multi-center trials targeting new treatments for cognition in schizophrenia.
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Affiliation(s)
- Leanne M Williams
- The Brain Dynamics Centre, Westmead Millennium Institute and Western Clinical School, University of Sydney, Westmead Hospital, NSW, 2145, Australia.
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Williams LM, Whitford TJ, Flynn G, Wong W, Liddell BJ, Silverstein S, Galletly C, Harris AWF, Gordon E. General and social cognition in first episode schizophrenia: identification of separable factors and prediction of functional outcome using the IntegNeuro test battery. Schizophr Res 2007. [PMID: 18053688 DOI: 10.1016/j.schres.2007.10.019.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVE It is increasingly recognized that cognitive assessments, unlike symptom ratings, provide a reliable predictor of functional outcome in schizophrenia. This study evaluated the utility of the 'IntegNeuro' computerized test battery for assessing cognition in first episode schizophrenia. We determined the presence of separable factors of general and social cognition, their equivalence to the consensus domains identified by the NIMH MATRICS project, and their effectiveness in predicting real world functional outcomes. METHOD Fifty six first episode schizophrenia (FES) patients and 112 matched healthy controls were assessed on the touchscreen-based 'IntegNeuro' cognitive test battery and FES patients for social functioning (SOFAS) and quality of life (WHOQOL-BREF). RESULTS Principal components analysis identified i) six factors corresponding to MATRICS domains of general cognition ('Information Processing Speed', 'Verbal Recall', 'Working Memory Capacity', 'Sustained Attention/Vigilance', 'Verbal Processing', 'Executive Function'), ii) an 'Emotional Intelligence' factor corresponding to the MATRICS social cognition domain, and iii) an additional 'Sensori-Motor Function' factor of general cognition and 'Negativity' factor of social cognition. Patients showed impairments relative to controls across all factors, but especially for Working Memory Capacity, followed by Verbal Memory, Sustained Attention/Vigilance and Negativity. These factors strongly predicted poorer social functioning in FES, along with poorer quality of life in psychological, social, and health satisfaction facets. CONCLUSION The IntegNeuro battery has utility for assessing separable domains of general and social cognition in FES, which are predictive of real world outcomes. Thus, it may be appropriate for clinical application, including in multi-center trials targeting new treatments for cognition in schizophrenia.
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Affiliation(s)
- Leanne M Williams
- The Brain Dynamics Centre, Westmead Millennium Institute and Western Clinical School, University of Sydney, Westmead Hospital, NSW, 2145, Australia.
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Williams LM, Kemp AH, Felmingham K, Liddell BJ, Palmer DM, Bryant RA. Neural Biases to Covert and Overt Signals of Fear: Dissociation by Trait Anxiety and Depression. J Cogn Neurosci 2007; 19:1595-608. [PMID: 17854280 DOI: 10.1162/jocn.2007.19.10.1595] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract
Although biases toward signals of fear may be an evolutionary adaptation necessary for survival, heightened biases may be maladaptive and associated with anxiety or depression. In this study, event-related potentials (ERPs) were used to examine the time course of neural responses to facial fear stimuli (versus neutral) presented overtly (for 500 msec with conscious attention) and covertly (for 10 msec with immediate masking to preclude conscious awareness) in 257 nonclinical subjects. We also examined the impact of trait anxiety and depression, assessed using psychometric ratings, on the time course of ERPs. In the total subject group, controlled biases to overtly processed fear were reflected in an enhancement of ERPs associated with structural encoding (120–220 msec) and sustained evaluation persisting from 250 msec and beyond, following a temporo-occipital to frontal topography. By contrast, covert fear processing elicited automatic biases, reflected in an enhancement of ERPs prior to structural encoding (80–180 msec) and again in the period associated with automatic orienting and emotion encoding (230–330 msec), which followed the reverse frontal to temporo-occipital topography. Higher levels of trait anxiety (in the clinical range) were distinguished by a heightened bias to covert fear (speeding of early ERPs), compared to higher depression which was associated with an opposing bias to overt fear (slowing of later ERPs). Anxiety also heightened early responses to covert fear, and depression to overt fear, with subsequent deficits in emotion encoding in each case. These findings are consistent with neural biases to signals of fear which operate automatically and during controlled processing, feasibly supported by parallel networks. Heightened automatic biases in anxiety may contribute to a cycle of hypervigilance and anxious thoughts, whereas depression may represent a “burnt out” emotional state in which evaluation of fear stimuli is prolonged only when conscious attention is allocated.
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Liddell BJ, Paul RH, Arns M, Gordon N, Kukla M, Rowe D, Cooper N, Moyle J, Williams LM. Rates of decline distinguish Alzheimer's disease and mild cognitive impairment relative to normal aging: integrating cognition and brain function. J Integr Neurosci 2007; 6:141-74. [PMID: 17472227 DOI: 10.1142/s0219635207001374] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 02/19/2007] [Indexed: 11/18/2022] Open
Abstract
AIMS Increasing age is the strongest risk factor for Alzheimer's disease (AD). Yet, departure from normal age-related decline for established markers of AD including memory, cognitive decline and brain function deficits, has not been quantified. METHODS We examined the cross-sectional estimates of the "rate of decline" in cognitive performance and psychophysiological measures of brain function over age in AD, preclinical (subjective memory complaint-SMC, Mild Cognitive Impairment-MCI) and healthy groups. Correlations between memory performance and indices of brain function were also conducted. RESULTS The rate of cognitive decline increased between groups: AD showed advanced decline, and SMC/MCI groups represented intermediate stages of decline relative to normal aging expectations. In AD, advanced EEG alterations (excessive slow-wave/reduced fast-wave EEG, decreased working memory P450 component) were observed over age, which were coupled with memory decline. By contrast, MCI group showed less severe cognitive changes but specific decreases in the working memory N300 component and slow-wave (delta) EEG, associated with decline in memory. DISCUSSION AND INTEGRATIVE SIGNIFICANCE: While the cognitive data suggests a continuum of deterioration associated with increasing symptom severity across groups, integration with brain function measures points to possible distinct compensatory strategies in MCI and AD groups. An integrative approach offers the potential for objective markers of the critical turning point, with age as a potential factor, from mild memory problems to disease.
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Affiliation(s)
- Belinda J Liddell
- The Brain Resource International Database and the Brain Resource Company, NSW 2007, Australia.
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Williams LM, Das P, Liddell BJ, Olivieri G, Peduto AS, David AS, Gordon E, Harris AWF. Fronto-limbic and autonomic disjunctions to negative emotion distinguish schizophrenia subtypes. Psychiatry Res 2007; 155:29-44. [PMID: 17398080 DOI: 10.1016/j.pscychresns.2006.12.018] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Revised: 11/08/2006] [Accepted: 12/25/2006] [Indexed: 11/17/2022]
Abstract
Schizophrenia patients show a disconnection in amygdala-medial prefrontal cortex and autonomic arousal systems for processing fear. Concurrent functional magnetic resonance imaging [fMRI] and skin conductance recording were used to determine whether these disturbances are specific to fear, or present in response to other signals of danger. We also examined whether these disturbances distinguish a specific symptom profile. During scanning, 27 schizophrenia (13 paranoid, 14 nonparanoid) and 22 matched healthy control subjects viewed standardized facial expressions of fear, anger and disgust (versus neutral). Skin conductance responses [SCRs]were acquired simultaneously to assess phasic increases in arousal. 'With-arousal' versus 'without-arousal' responses were analysed using non-parametric methods. For controls, 'with-arousal' responses were associated with emotion-specific activity for fear (amygdala), disgust (insula) and anger (anterior cingulate), together with common medial prefrontal cortex [MPFC] engagement, as predicted. Schizophrenia patients displayed abnormally increased phasic arousal, with concomitant reductions in emotion-specific regions and MPFC. These findings may reflect a general disconnection between central and autonomic systems for processing signals of danger. This disjunction was most apparent in patients with a profile of paranoia, coupled with poor social function and insight. Heightened autonomic sensitivity to signals of fear, threat or contamination, without effective neural mechanisms for appraisal, may underlie paranoid delusions which concern threat and contamination, and associated social and interpersonal difficulties.
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Gatt JM, Clark CR, Kemp AH, Liddell BJ, Dobson-Stone C, Kuan SA, Schofield PR, Williams LM. A GENOTYPE-ENDOPHENOTYPE-PHENOTYPE PATH MODEL OF DEPRESSED MOOD: INTEGRATING COGNITIVE AND EMOTIONAL MARKERS. J Integr Neurosci 2007; 6:75-104. [PMID: 17472225 DOI: 10.1142/s0219635207001398] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 02/14/2007] [Indexed: 11/18/2022] Open
Abstract
AIMS Following an integrative neuroscience perspective, we propose that cognitive and emotional functions are integrally linked, and that genetic polymorphisms which impact upon neural processes may have complementary effects on these functions. The brain-derived neurotrophic factor (BDNF) 66Met allele may contribute to both cognitive and emotional aspects of the depression phenotype. METHODS In 374 nonclinical subjects, BDNF genotype differences in task-related ERPs, emotion, memory, and EEG cortical arousal were examined. RESULTS Using path modeling, higher negative affect in Met homozygotes was predicted by slow-wave EEG via the mediating effects of neuroticism. Both negative affect and working memory deficits were predicted by disturbances in emotion- and cognitive-related ERPs. This model held across groups with varying levels of depressed mood. DISCUSSION Since impairments in emotion and working memory are core features of major depression, the BDNF Met allele may contribute to vulnerability for this disorder. An integrative approach in which genotypes are considered in combination with brain function and behavioral measures may be important in identifying profile markers of depression. INTEGRATIVE SIGNIFICANCE This study directly demonstrates that cognitive and emotional neural networks are not parallel independent systems, but rather highly integrated with effects on both cognitive performance and emotional behavior.
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Affiliation(s)
- Justine M Gatt
- The Brain Dynamics Center, Westmead Millennium Institute, Westmead Hospital and Western Clinical School, University of Sydney, NSW 2145, Australia.
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Rowe DL, Cooper NJ, Liddell BJ, Clark CR, Gordon E, Williams LM. BRAIN STRUCTURE AND FUNCTION CORRELATES OF GENERAL AND SOCIAL COGNITION. J Integr Neurosci 2007; 6:35-74. [PMID: 17472224 DOI: 10.1142/s021963520700143x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 02/28/2007] [Indexed: 11/18/2022] Open
Abstract
AIMS To examine how general (e.g., memory, attention) and social (emotional and interpersonal processes) cognition relate to measures of brain function and structure. METHODS PCA was used to identify general and social cognitive factors from Brain Resource International Database in 1,316 subjects. The identified factors were correlated with each subject's corresponding brain structure (MRI) and function (EEG/ERP) data. RESULTS Seven core cognitive factors were identified for general and three for social. General cognition was correlated with global grey matter, while social cognition was negatively correlated with grey matter in fronto-temporal-somatosensory regions. Executive function, information processing speed and verbal memory performance were correlated with delta-theta qEEG, while most general cognitive factors negatively correlated with beta qEEG. Faster information processing speed was correlated with alpha qEEG. Executive function and information processing speed was correlated with negative-going ERP amplitude and slower ERP latency at frontal sites, but at posterior sites negative correlations were found. DISCUSSION In contrast to general cognition, social cognition is identified by different functional (automated) activity and more localized neural structures. Only general cognition, requiring more effortful, controlled processing is related to brain function measures, particularly in frontal cortices. INTEGRATIVE SIGNIFICANCE Recording measures from multiple modalities including MRI, EEG/ERP, social and general cognition within the same subject provides a method of brain profiling for use in cognitive-neurotherapy and pharmacological studies.
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Affiliation(s)
- Donald L Rowe
- The Brain Dynamics Center, Westmead Millennium Institute, Westmead Hospital and Western Clinical School, University of Sydney, NSW 2145, Australia.
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Gordon E, Liddell BJ, Brown KJ, Bryant R, Clark CR, DAS P, Dobson-Stone C, Falconer E, Felmingham K, Flynn G, Gatt JM, Harris A, Hermens DF, Hopkinson PJ, Kemp AH, Kuan SA, Lazzaro I, Moyle J, Paul RH, Rennie CJ, Schofield P, Whitford T, Williams LM. INTEGRATING OBJECTIVE GENE-BRAIN-BEHAVIOR MARKERS OF PSYCHIATRIC DISORDERS. J Integr Neurosci 2007; 6:1-34. [PMID: 17472223 DOI: 10.1142/s0219635207001465] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 02/28/2007] [Indexed: 11/18/2022] Open
Abstract
There is little consensus about which objective markers should be used to assess major psychiatric disorders, and predict/evaluate treatment response for these disorders. Clinical practice relies instead on subjective signs and symptoms, such that there is a "translational gap" between research findings and clinical practice. This gap arises from: a) a lack of integrative theoretical models which provide a basis for understanding links between gene-brain-behavior mechanisms and clinical entities; b) the reliance on studying one measure at a time so that linkages between markers are their specificity are not established; and c) the lack of a definitive understanding of what constitutes normative function. Here, we draw on a standardized methodology for acquiring multiple sources of genomic, brain and behavioral data in the same subjects, to propose candidate markers of selected psychiatric disorders: depression, post-traumatic stress disorder, schizophrenia, attention-deficit/hyperactivity disorder and dementia disorders. This methodology has been used to establish a standardized international database which provides a comprehensive framework and the basis for testing hypotheses derived from an integrative theoretical model of the brain. Using this normative base, we present preliminary findings for a number of disorders in relation to the proposed markers. Establishing these objective markers will be the first step towards determining their sensitivity, specificity and treatment prediction in individual patients.
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Affiliation(s)
- Evian Gordon
- The Brain Resource International Database and the Brain Resource Company, Sydney, NSW 2007, Australia.
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Das P, Kemp AH, Flynn G, Harris AWF, Liddell BJ, Whitford TJ, Peduto A, Gordon E, Williams LM. Functional disconnections in the direct and indirect amygdala pathways for fear processing in schizophrenia. Schizophr Res 2007; 90:284-94. [PMID: 17222539 DOI: 10.1016/j.schres.2006.11.023] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Revised: 11/20/2006] [Accepted: 11/25/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Schizophrenia patients show reduced neural activity, relative to controls, in the amygdala and its projection to the medial prefrontal cortex (MPFC) in response to fear perception. In this study we tested the hypothesis that schizophrenia is characterized by abnormal functional connectivity in the amygdala network underlying fear perception. METHODS Functional MRI images were acquired from 14 schizophrenia patients and 14 matched healthy control subjects during an emotion perception task, in which fearful and neutral facial expression stimuli were presented pseudorandomly under nonconscious (using masking) and conscious conditions. Both subtraction and functional connectivity analyses were undertaken using a region of interest approach. RESULTS In response to fearful facial expressions, schizophrenia patients displayed reduced amygdala activity, compared to controls, in both the conscious and nonconscious conditions. The amygdala displayed a reversal of the normal pattern of connectivity with the brainstem, visual cortex, and also with the dorsal and ventral divisions of the MPFC in the schizophrenia patients. CONCLUSIONS The presence of functional disconnections in amygdala pathways suggests that schizophrenia patients have a failure in coordinating their automatic orienting to salient signals and the associated prefrontal monitoring of these signals.
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Affiliation(s)
- Pritha Das
- Neuroscience Institute of Schizophrenia and Allied Disorders, Darlinghurst, NSW 2010, Australia.
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Williams LM, Das P, Liddell BJ, Kemp AH, Rennie CJ, Gordon E. Mode of functional connectivity in amygdala pathways dissociates level of awareness for signals of fear. J Neurosci 2006; 26:9264-71. [PMID: 16957082 PMCID: PMC6674508 DOI: 10.1523/jneurosci.1016-06.2006] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Many of the same regions of the human brain are activated during conscious attention to signals of fear and in the absence of awareness for these signals. The neural mechanisms that dissociate level of awareness from activation in these regions remain unknown. Using functional magnetic resonance imaging with connectivity analysis in healthy human subjects, we demonstrate that level of awareness for signals of fear depends on mode of functional connectivity in amygdala pathways rather than discrete patterns of activation in these pathways. Awareness for fear relied on negative connectivity within both cortical and subcortical pathways to the amygdala, suggesting that reentrant feedback may be necessary to afford such awareness. In contrast, responses to fear in the absence of awareness were supported by positive connections in a direct subcortical pathway to the amygdala, consistent with the view that excitatory feedforward connections along this pathway may be sufficient for automatic responses to "unseen" fear.
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Affiliation(s)
- Leanne M Williams
- The Brain Dynamics Centre, Westmead Millenium Institute and University of Sydney, Sydney, New South Wales, 2145, Australia.
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Williams LM, Liddell BJ, Kemp AH, Bryant RA, Meares RA, Peduto AS, Gordon E. Amygdala-prefrontal dissociation of subliminal and supraliminal fear. Hum Brain Mapp 2006; 27:652-61. [PMID: 16281289 PMCID: PMC6871444 DOI: 10.1002/hbm.20208] [Citation(s) in RCA: 173] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Accepted: 08/19/2005] [Indexed: 11/08/2022] Open
Abstract
Facial expressions of fear are universally recognized signals of potential threat. Humans may have evolved specialized neural systems for responding to fear in the absence of conscious stimulus detection. We used functional neuroimaging to establish whether the amygdala and the medial prefrontal regions to which it projects are engaged by subliminal fearful faces and whether responses to subliminal fear are distinguished from those to supraliminal fear. We also examined the time course of amygdala-medial prefrontal responses to supraliminal and subliminal fear. Stimuli were fearful and neutral baseline faces, presented under subliminal (16.7 ms and masked) or supraliminal (500 ms) conditions. Skin conductance responses (SCRs) were recorded simultaneously as an objective index of fear perception. SPM2 was used to undertake search region-of-interest (ROI) analyses for the amygdala and medial prefrontal (including anterior cingulate) cortex, and complementary whole-brain analyses. Time series data were extracted from ROIs to examine activity across early versus late phases of the experiment. SCRs and amygdala activity were enhanced in response to both subliminal and supraliminal fear perception. Time series analysis showed a trend toward greater right amygdala responses to subliminal fear, but left-sided responses to supraliminal fear. Cortically, subliminal fear was distinguished by right ventral anterior cingulate activity and supraliminal fear by dorsal anterior cingulate and medial prefrontal activity. Although subcortical amygdala activity was relatively persistent for subliminal fear, supraliminal fear showed more sustained cortical activity. The findings suggest that preverbal processing of fear may occur via a direct rostral-ventral amygdala pathway without the need for conscious surveillance, whereas elaboration of consciously attended signals of fear may rely on higher-order processing within a dorsal cortico-amygdala pathway.
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Affiliation(s)
- Leanne M Williams
- Brain Dynamics Centre, Westmead Hospital, Westmead Sydney, NSW, Australia.
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Williams LM, Brown KJ, Palmer D, Liddell BJ, Kemp AH, Olivieri G, Peduto A, Gordon E. The mellow years?: neural basis of improving emotional stability over age. J Neurosci 2006; 26:6422-30. [PMID: 16775129 PMCID: PMC6674038 DOI: 10.1523/jneurosci.0022-06.2006] [Citation(s) in RCA: 200] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Contrary to the pervasive negative stereotypes of human aging, emotional functions may improve with advancing age. However, the brain mechanisms underlying changes in emotional function over age remain unknown. Here, we demonstrate that emotional stability improves linearly over seven decades (12-79 years) of the human lifespan. We used both functional magnetic resonance imaging and event-related potential recording to examine the neural basis of this improvement. With these multimodal techniques, we show that better stability is predicted by a shift toward greater medial prefrontal control over negative emotional input associated with increased activity later in the processing sequence (beyond 200 ms after stimulus) and less control over positive input, related to a decrease in early activity (within 150 ms). This shift was independent from gray matter loss, indexed by structural magnetic resonance data. We propose an integrative model in which accumulated life experience and the motivation for meaning over acquisition in older age contribute to plasticity of medial prefrontal systems, achieving a greater selective control over emotional functions.
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Affiliation(s)
- Leanne M Williams
- Brain Dynamics Centre, Westmead Millenium Institute and Western Clinical School, University of Sydney, Westmead Hospital, Westmead, Sydney, New South Wales, 2145, Australia.
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