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Ravi M, Mekawi Y, Blevins EJ, Michopoulos V, Stevens J, Carter S, Powers A. Intersections of oppression: Examining the interactive effect of racial discrimination and neighborhood poverty on PTSD symptoms in Black women. J Psychopathol Clin Sci 2023; 132:567-576. [PMID: 37079842 PMCID: PMC10293083 DOI: 10.1037/abn0000818] [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] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Black Americans living in urban environments are disproportionately impacted by posttraumatic stress disorder (PTSD). Both racial discrimination and neighborhood poverty are factors that contribute to this health disparity. However, studies focused on the intersection of these two oppressive systems on PTSD symptoms are lacking. To address this gap in the literature, we assessed the interactive effects of racial discrimination and neighborhood poverty on PTSD symptoms in an urban sample of trauma-exposed Black women (N = 300). Simple moderation analysis was used to assess the main and interactive effects of racial discrimination and neighborhood poverty on PTSD symptoms. The overall model significantly predicted PTSD symptoms, with a main effect of racial discrimination (B = 1.87, p = .009) and neighborhood poverty rate (B = 0.29, p = .008), independent of prior trauma exposure and percentage of Black residents in the zip code. More frequent experiences of racial discrimination and higher rates of neighborhood poverty both predicted higher PTSD symptoms. There was also a trending interaction of racial discrimination and neighborhood poverty (B = -0.05, p = .054), where the effect of neighborhood poverty on PTSD symptoms was only present for those who reported fewer experiences of racial discrimination. Our results suggest that people who have experienced more instances of racial discrimination show high levels of PTSD symptoms regardless of neighborhood poverty rates and highlight the importance of considering multiple levels of oppression that Black individuals face while diagnosing and treating stress-related psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Meghna Ravi
- Emory University, Graduate Program in Neuroscience
| | - Yara Mekawi
- University of Louisville, Department of Psychological and Brain Sciences
| | - Emily J. Blevins
- University of Illinois at Urbana-Champaign, Department of Psychology
| | | | - Jennifer Stevens
- Emory University, Department of Psychiatry and Behavioral Sciences
| | | | - Abigail Powers
- Emory University, Department of Psychiatry and Behavioral Sciences
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Redican E, Vang ML, Shevlin M, Ghazali S, Elklit A. The co-occurrence of potentially traumatic events (PTEs) and their associations with posttraumatic stress disorder (PTSD) in Indian and Malaysian adolescents. Acta Psychol (Amst) 2023; 235:103896. [PMID: 36990035 DOI: 10.1016/j.actpsy.2023.103896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/19/2022] [Revised: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Although it is well-established that people can experience multiple traumatic events, there are few studies examining the co-occurrence of such experiences in non-Western nations. The current study sought to examine the occurrence of multiple potentially traumatic experiences (PTEs) and their associations with posttraumatic stress disorder (PTSD) among adolescents from two Asian nations. METHODS Latent class analysis (LCA) was employed to model the co-occurrence of PTEs in two school samples of adolescents from India (n = 411) and Malaysia (n = 469). Demographic correlates (i.e., sex, age, household composition, parent education) of the latent classes and the association between latent class membership and probable diagnosis of posttraumatic stress disorder (PTSD) were examined. RESULTS The LCA identified three latent classes for the Indian sample: 'Low Risk - moderate sexual trauma', 'Moderate Risk', and 'High Risk'. Similarly, three classes were also identified for the Malaysian sample: 'Low Risk', 'Moderate Risk', and 'High Risk'. Membership of 'Moderate Risk' was associated with male sex in both samples, and with older age and lower levels of parental education attainment in the Malaysian sample. No correlates of 'High Risk' class were identified in either sample. Membership of the 'High Risk' class was significantly associated with probable PTSD diagnosis in both samples, while membership of the 'Moderate Risk' class was associated with probable PTSD diagnosis in the Malaysian sample. CONCLUSION Findings from this study correspond with Western studies indicating co-occurrence of PTEs to be common and to represent a salient risk factor for the development of PTSD.
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Affiliation(s)
- Enya Redican
- Department of Psychology, Ulster University, United Kingdom.
| | - Maria Louison Vang
- Department of Psychology, The National Center of Psychotraumatology, Denmark.
| | - Mark Shevlin
- Department of Psychology, Ulster University, United Kingdom.
| | - Siti Ghazali
- Department of Psychological Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Malaysia.
| | - Ask Elklit
- Department of Psychology, The National Center of Psychotraumatology, Denmark.
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Meredith LS, Wong E, Osilla KC, Sanders M, Tebeka MG, Han B, Williamson SL, Carton TW. Trauma-informed Collaborative Care for African American Primary Care Patients in Federally Qualified Health Centers: A Pilot Randomized Trial. Med Care 2022; 60:232-239. [PMID: 35157622 PMCID: PMC8867914 DOI: 10.1097/mlr.0000000000001681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND African Americans have nearly double the rate of posttraumatic stress disorder (PTSD) compared with other racial/ethnic groups. OBJECTIVE To understand whether trauma-informed collaborative care (TICC) is effective for improving PTSD among African Americans in New Orleans who receive their care in Federally Qualified Health Centers (FQHCs). DESIGN AND METHOD In this pilot randomized controlled trial, we assigned patients within a single site to either TICC or to enhanced usual care (EUC). We performed intent to treat analysis by nonparametric exact tests for small sample sizes. PARTICIPANTS We enrolled 42 patients from October 12, 2018, through July 2, 2019. Patients were eligible if they considered the clinic their usual source of care, had no obvious physical or cognitive obstacles that would prevent participation, were age 18 or over, self-identified as African American, and had a provisional diagnosis of PTSD. MEASURES Our primary outcome measures were PTSD measured as both a symptom score and a provisional diagnosis based on the PTSD Checklist for DSM-5 (PCL-5). KEY RESULTS Nine months following baseline, both PTSD symptom scores and provisional PTSD diagnosis rates decreased substantially more for patients in TICC than in EUC. The decreases were by 26 points in EUC and 36 points in TICC for symptoms (P=0.08) and 33% in EUC and 57% in TICC for diagnosis rates (P=0.27). We found no effects for mediator variables. CONCLUSIONS TICC shows promise for addressing PTSD in this population. A larger-scale trial is needed to fully assess the effectiveness of this approach in these settings.
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Affiliation(s)
- Lisa S. Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
- VA HSR&D Center for Healthcare Innovation, Implementation & Policy, 16111 Plummer St, North Hills, CA, USA
| | - Eunice Wong
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
| | | | - Margaret Sanders
- Louisiana Public Health Institute, 1515 Poydras Street, Suite 1200, New Orleans, LA, USA
| | | | - Bing Han
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
| | | | - Thomas W. Carton
- Louisiana Public Health Institute, 1515 Poydras Street, Suite 1200, New Orleans, LA, USA
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Schiess-Jokanovic J, Knefel M, Kantor V, Weindl D, Schäfer I, Lueger-Schuster B. Complex post-traumatic stress disorder and post-migration living difficulties in traumatised refugees and asylum seekers: the role of language acquisition and barriers. Eur J Psychotraumatol 2021; 12:2001190. [PMID: 34900122 PMCID: PMC8654416 DOI: 10.1080/20008198.2021.2001190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background Numerous traumatic experiences and post-migration living difficulties (PMLDs) increase the risk of developing symptoms of complex post-traumatic stress disorder (CPTSD) among Afghan refugees and asylum seekers, living in Austria. Research has repeatedly associated higher levels of CPTSD with higher levels of PMLDs. Summarizing PMLDs into empirically derived factors might facilitate a further understanding of their interaction with symptom presentation within distinct clusters of CPTSD. Objective The current study aimed to investigate homogeneous subgroups of ICD-11 CPTSD and their association with demographic variables, traumatic experiences, and empirically derived factors of PMLDs. Method Within a randomized controlled trail (RCT) CPTSD, PMLDs, and traumatic experiences were assessed in a sample of 93 treatment-seeking Afghan refugees and asylum seekers through a fully structured face-to-face and interpreter-assisted interview using the ITQ, the PMLDC, and a trauma checklist. Underlying clusters of CPTSD, superior factors of PMLDs, and their associations were investigated. Results In total, 19.4% of the sample met the diagnostic criteria for PTSD and 49.5% for CPTSD. We identified a 2-cluster solution consisting of two distinct subgroups as best fitting: (1) a CPTSD cluster and (2) a PTSD cluster. The multitude of PMLDs was summarized into four superior factors. CPTSD cluster membership was associated with childhood potentially traumatic experience types, and one of four PMLD factors, namely 'language acquisition & barriers'. Conclusions The results suggest that not PMLDs in general, but rather specific types of PMLDs, are associated with CPTSD. An assumed bidirectional relationship between these PMLD factors and CPTSD symptoms might lead to a downward spiral of increasing distress, and could be considered in treatment strategies.
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Affiliation(s)
- Jennifer Schiess-Jokanovic
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Matthias Knefel
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Viktoria Kantor
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Dina Weindl
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Brigitte Lueger-Schuster
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
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Yamin JB, Sudan S, Lumley MA, Dhalimi A, Arnetz JE, Stemmer PM, Burghardt PR, Jamil H, Arnetz BB. The Development of Posttraumatic Stress Disorder and Depression Symptoms in Iraqi Refugees: Associations with Acculturation and C-reactive Protein. J Nerv Ment Dis 2021; 209:585-591. [PMID: 33958551 PMCID: PMC8544132 DOI: 10.1097/nmd.0000000000001360] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ABSTRACT Refugees experience distress from premigration trauma, often exacerbated by postmigration difficulties. To develop effective interventions, risk factors for mental health symptoms need to be determined. Male Iraqi refugees (N = 53) to the United States provided background information and reported predisplacement trauma and psychological health within 1 month of their arrival. An inflammatory biomarker-C-reactive protein (CRP) was assessed approximately 1.5 years after arrival, and a contextual factor-acculturation-and psychological health were assessed 2 years after arrival. We tested whether acculturation and CRP were associated with posttraumatic stress disorder (PTSD) and depression symptoms at the 2-year follow-up, controlling for baseline symptoms, age, body mass index, and predisplacement trauma. Acculturation was inversely related to depression, and CRP was positively related to both PTSD and depression at the 2-year follow-up. Interventions targeting acculturation could help reduce the development of depression symptoms in refugees. The role of CRP in the development of PTSD and depression symptoms warrants further research.
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Affiliation(s)
- Jolin B. Yamin
- Department of Psychology, Wayne State University, Detroit, MI, US
| | - Sukhesh Sudan
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, US
| | - Mark A. Lumley
- Department of Psychology, Wayne State University, Detroit, MI, US
| | - Abir Dhalimi
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, US
| | - Judith E. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, US
| | - Paul M. Stemmer
- Institute of Environmental Health Sciences, Wayne State University, Detroit, MI, US
| | - Paul R. Burghardt
- Department of Food and Nutrition Science, Wayne State University, Detroit, MI, US
| | - Hikmet Jamil
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, US
| | - Bengt B. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, US
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Scherer N, Hameed S, Acarturk C, Deniz G, Sheikhani A, Volkan S, Örücü A, Pivato I, Akıncı İ, Patterson A, Polack S. Prevalence of common mental disorders among Syrian refugee children and adolescents in Sultanbeyli district, Istanbul: results of a population-based survey. Epidemiol Psychiatr Sci 2020; 29:e192. [PMID: 33298230 PMCID: PMC7737189 DOI: 10.1017/s2045796020001079] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 09/07/2020] [Revised: 11/02/2020] [Accepted: 11/08/2020] [Indexed: 11/06/2022] Open
Abstract
AIMS Research demonstrates elevated levels of common mental disorders among Syrian refugees, but the majority of studies have, to date, focused on adult populations. This study aims to estimate the prevalence of depression, anxiety and post-traumatic stress disorder (PTSD) among Syrian children and adolescents living in Sultanbeyli district of Istanbul, Turkey. METHODS A population-based survey among Syrian children and adolescents aged 8-17 years living in Sultanbeyli district was conducted in 2019, as part of an all-age survey of disability. 80 clusters of 50 participants (all-ages) were selected from the local municipality's refugee registration database using probability proportionate to size sampling. Children aged 8-17 years were assessed for symptoms of common mental disorders using the Child Revised Impact of Event Scale (CRIES-8) and abbreviated versions of the Center for Epidemiologic Studies Depression Scale for Children (CES-DC) and the Screen for Child Anxiety Related Disorders (SCARED). RESULTS Of the 852 participants, 23.7% (95% CI 19.9-27.2) screened positive for symptomatic depression, PTSD and anxiety. The prevalence estimates for depression, PTSD and anxiety were 12.5% (95% CI 9.8-15.6), 11.5% (95% CI 9.1-14.4) and 9.2% (95% CI 6.8-12.1), respectively. Depression and PTSD were significantly more common in older adolescents, whilst anxiety and PTSD were significantly more common in girls. Depression was more common in children from poorer households and those who had received no education. Children coming from larger households were less likely to show symptoms of PTSD. CONCLUSIONS Syrian refugee children and adolescents are vulnerable to common mental disorders, and culturally appropriate prevention and intervention support are needed for this population.
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Affiliation(s)
- N. Scherer
- Department of Clinical Research, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - S. Hameed
- Department of Clinical Research, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - C. Acarturk
- Department of Psychology, Koç University, Istanbul, Turkey
| | - G. Deniz
- Mülteciler Derneği, Istanbul, Turkey
| | | | - S. Volkan
- Relief International, Istanbul, Turkey
| | - A. Örücü
- Mülteciler Derneği, Istanbul, Turkey
| | - I. Pivato
- Relief International, Istanbul, Turkey
| | - İ. Akıncı
- Mülteciler Derneği, Istanbul, Turkey
| | | | - S. Polack
- Department of Clinical Research, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Röhr S, Jung FU, Renner A, Plexnies A, Hoffmann R, Dams J, Grochtdreis T, König HH, Kersting A, Riedel-Heller SG. Recruitment and Baseline Characteristics of Participants in the "Sanadak" Trial: A Self-Help App for Syrian Refugees with Post-traumatic Stress. Int J Environ Res Public Health 2020; 17:ijerph17207578. [PMID: 33081070 PMCID: PMC7589335 DOI: 10.3390/ijerph17207578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/20/2022]
Abstract
Many Syrian refugees residing in Germany have been exposed to traumatizing events, while treatment options are scarce. Therefore, the self-help app “Sanadak” was developed to target post-traumatic stress in Syrian refugees. We aimed to inspect the recruitment and baseline characteristics of the participants in the trial, which is conducted to evaluate the app. Analyses were based on the recruitment sample (n = 170) and the trial sample (n = 133). Data were collected during structured face-to-face interviews in the Arabic language. Targeted outcomes included post-traumatic stress (primary; Post-traumatic Diagnostic Scale for DSM-5/PDS-5) and depressive symptoms, anxiety, resilience, among others (secondary). Recruited individuals were M = 32.8 (SD = 11.2, range = 18–65) years old; 38.8% were women. The average PDS-5 score was 23.6 (SD = 13.2) regarding trauma exposure, which was most frequently related to experiencing military- or combat-related events (32.9%). Moreover, 46.5% had major depression and 51.8% showed low resilience. Anxiety was present in 40.6% of the trial participants. Psychological distress was high in Syrian refugees residing in Germany, enrolled in a trial targeting post-traumatic stress. This underlines the need for intervention. Our results provide important figures on the mental health of a not well-studied population group in Germany.
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Affiliation(s)
- Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (F.U.J.); (S.G.R.-H.)
- Global Brain Health Institute (GBHI), Trinity College Dublin, D02 PN40 Dublin, Ireland
- Correspondence: ; Tel.: +49-341-9724568; Fax: +49-341-9715409
| | - Franziska U. Jung
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (F.U.J.); (S.G.R.-H.)
| | - Anna Renner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, 04103 Leipzig, Germany; (A.R.); (A.P.); (R.H.); (A.K.)
| | - Anna Plexnies
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, 04103 Leipzig, Germany; (A.R.); (A.P.); (R.H.); (A.K.)
| | - Rahel Hoffmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, 04103 Leipzig, Germany; (A.R.); (A.P.); (R.H.); (A.K.)
| | - Judith Dams
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.D.); (T.G.); (H-H.K.)
| | - Thomas Grochtdreis
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.D.); (T.G.); (H-H.K.)
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.D.); (T.G.); (H-H.K.)
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, 04103 Leipzig, Germany; (A.R.); (A.P.); (R.H.); (A.K.)
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (F.U.J.); (S.G.R.-H.)
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Rometsch C, Denkinger JK, Engelhardt M, Windthorst P, Graf J, Nikendei C, Zipfel S, Junne F. Care providers' views on burden of psychosomatic symptoms of IS-traumatized female refugees participating in a Humanitarian Admission Program in Germany: A qualitative analysis. PLoS One 2020; 15:e0239969. [PMID: 33017408 PMCID: PMC7535032 DOI: 10.1371/journal.pone.0239969] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 09/17/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Traumatized refugees often suffer from diverse psychosomatic symptoms. Female Yazidi refugees from Northern Iraq who survived attacks of the so-called "Islamic State" were brought to Germany to receive special medical and psychotherapeutic treatment in a unique worldwide humanitarian admission program (HAP). Here, we report on their psychosomatic symptoms and helpful strategies from the perspective of care providers. METHODS Care providers (N = 84) in this HAP were interviewed in an individual setting as well as in focus groups to gather information about the HAP beneficiaries' psychosomatic symptoms. Data analysis followed Qualitative Content Analysis by Mayring. RESULTS The care providers reported five main psychological burdens of the Yazidis: 1) insecurity regarding loss, 2) worries about family members, 3) ambivalence about staying in Germany or returning to Iraq, 4) life between two worlds and 5) re-actualization of the traumatic experiences. The predominant psychological symptoms the care providers noticed were fear, depressive symptoms, feelings of guilt, and sleep and eating disorders. Regarding somatic symptoms, the care providers mainly received complaints about pain in the head, back, chest and stomach. Helpful strategies for providing adequate health care were care providers' cooperating with physicians, precise documentation of beneficiaries' symptoms, and additional support in directing the beneficiaries through the health care system. Regarding psychotherapy, interpreters help to overcome language barriers, onsite psychotherapy, flexible therapy appointments, psychoeducational methods, time for stabilization, and support in coping with daily life aspects. In the care providers' experience, psychotherapists have to build a relationship of trust. After grief therapy, a trauma-specific therapy in a culturally adapted way is possible. CONCLUSION The HAP is a unique model health care program to offer highly traumatized refugees medical and psychological help. Care providers reported on several (psycho-)somatic symptoms of the traumatized women. The strategies the HAP care providers perceived as helpful can be recommended for similar projects in the future.
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Affiliation(s)
- Caroline Rometsch
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Jana Katharina Denkinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martha Engelhardt
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Petra Windthorst
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
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Guo J, Yang Y, Jiang X, Guo M, Li X, Huang P, Liu Z. Differential promoter methylation and G-712A polymorphism of brain-derived neurotrophic factor in post-traumatic stress disorder patients of Li and Han populations in Hainan province. Gene 2020; 769:145192. [PMID: 33007373 DOI: 10.1016/j.gene.2020.145192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/15/2020] [Revised: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 12/15/2022]
Abstract
This study aimed to explore the correlations of promoter methylation and single-nucleotide polymorphism (SNP) of brain-derived neurotrophic factor (BDNF) with post-traumatic stress disorder (PTSD) in Li and Han nationalities in Hainan province. Depression- and anxiety-related questionnaires were performed for PTSD-related information collection and analysis, with 164 PTSD patients and 141 healthy controls included. Serum BDNF level was measured and the methylation of BDNF promoter was evaluated. The BDNF SNP genotyping was performed, after which the risk genotypes for PTSD were detected and analyzed using logistic regression analysis. Our study found that the PTSD incidence was different in Li and Han nationalities. Serum BDNF level in PTSD patients in Li nationality was obviously lower than that in patients in Han nationality, while the methylation of BDNF promoter was higher in patients in Li nationality. The G-712A rather than rs6265 genotypes presented significant difference between PTSD patients and healthy controls. Meanwhile, the patients in Li nationality with AG genotype at G-712A inclined to depression, and patients with GG genotype had a greater degree of PTSD. G-712A and promoter methylation of BDNF were independent risk factors for PTSD. Our study demonstrated that the differences of PTSD patients between Li and Han nationalities were attributed by SNP G-712A genotypes and promoter methylation of BDNF.
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Affiliation(s)
- Juncheng Guo
- Department of Hepatobiliary Surgery, Central South University Xiangya School of Medical Affiliated Haikou Hospital, Haikou 570208, Hainan, PR China
| | - Yijun Yang
- Department of Hepatobiliary Surgery, Central South University Xiangya School of Medical Affiliated Haikou Hospital, Haikou 570208, Hainan, PR China
| | - Xiangling Jiang
- Psychological Research Center, Hainan General Hospital, Haikou 570311, Hainan, PR China
| | - Min Guo
- Psychological Research Center, Hainan General Hospital, Haikou 570311, Hainan, PR China.
| | - Xiang Li
- The Third People's Hospital of Hubei Province, Wuhan 430032, Hubei, PR China
| | - Ping Huang
- University of South China, Hengyang 421001, Hunan, PR China
| | - Zhuo Liu
- Psychological Research Center, Hainan General Hospital, Haikou 570311, Hainan, PR China
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10
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Cardeli E, Phan J, Mulder L, Benson M, Adhikari R, Ellis BH. Bhutanese Refugee Youth: The Importance of Assessing and Addressing Psychosocial Needs in a School Setting. J Sch Health 2020; 90:731-742. [PMID: 32715496 DOI: 10.1111/josh.12935] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 12/10/2019] [Accepted: 01/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Traumatic exposure combined with significant stressors in resettlement place Bhutanese refugees at risk for mental health problems. Despite this, refugee youth often are reluctant to seek mental health services. Psychosocial support services, such as school-based groups, offer one solution to this barrier to care. We had 2 aims in this study: (1) to describe the psychosocial needs of resettled Bhutanese refugee students; and (2) to evaluate the impact of skills-based groups on these students' sense of school belonging and mental health. METHODS Bhutanese refugee students in middle school (N = 34) participated in the 12-week group curriculum (a component of Trauma Systems Therapy for Refugees) and the associated preevaluation/postevaluation. RESULTS Baseline descriptive analyses indicated high levels of mental health symptoms; approximately, 49% of students met partial or full criteria for posttraumatic stress disorder. In addition, sense of school belonging was significantly inversely associated with depressive and posttraumatic stress symptoms at baseline. Paired sample t tests indicate that students' avoidance symptoms significantly decreased postintervention. CONCLUSIONS Findings suggest that skills-based groups may be an effective way to engage students in supportive services and address psychosocial needs. Results further highlight the potential protective role of school belonging in reducing refugee students' vulnerability to psychological distress.
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Affiliation(s)
- Emma Cardeli
- Research Associate and Attending Psychologist, , Department of Psychiatry, Boston Children's Hospital, Boston, MA; Instructor, Harvard Medical School, Refugee Trauma and Resilience Center, 21 Autumn Street, Boston, MA 02215., USA
| | - Jenny Phan
- Graduate Student in Clinical Psychology, , Psychology Department, Loyola University Chicago, 1000 W. Sheridan Rd, Coffey Hall, Chicago, IL 60626., USA
| | - Luna Mulder
- Psychologist, , Department of Psychiatry, Boston Children's Hospital, Boston, MA; Instructor, Harvard Medical School, Refugee Trauma & Resilience Center, 21 Autumn Street, Boston, MA 02115., USA
| | - Molly Benson
- Attending Psychologist, , Department of Psychiatry, Boston Children's Hospital, Boston, MA; Assistant Professor (Part-time), Harvard Medical School, Refugee Trauma & Resilience Center, P.O. Box 1384, Concord, MA 01742., USA
| | - Radha Adhikari
- Outpatient Clinician and Community Support Program Worker, , Behavioral Health Network, 1504 Galena St, Aurora, CO 80010., USA
| | - B Heidi Ellis
- Director, , Refugee Trauma and Resilience Center, Department of Psychiatry, Boston Children's Hospital, Boston, MA; Associate Professor, Harvard Medical School21 Autumn St. Boston, MA 02215., USA
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11
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Abstract
Ghost encounters were found to be a key part of the trauma ontology among Cambodian refugees at a psychiatric clinic, a key idiom of distress. Fifty-four percent of patients had been bothered by ghost encounters in the last month. The severity of being bothered by ghosts in the last month was highly correlated to PTSD severity (r = .8), and among patients bothered by ghosts in the last month, 85.2% had PTSD, versus among those not so bothered, 15.4%, odds ratio of 31.8 (95% confidence level 11.3-89.3), Chi square = 55.0, p < .001. Ghost visitations occurred in multiple experiential modalities that could be classified into three states of consciousness: full sleep (viz., in dream), hypnagogia, that is, upon falling asleep or awakening (viz., in sleep paralysis [SP] and in non-SP hallucinations), and full waking (viz., in hallucinations, visual aura, somatic sensations [chills or goosebumps], and leg cramps). These ghost visitations gave rise to multiple concerns-for example, of being frightened to death or of having the soul called away-as part of an elaborate cosmology. Several heuristic models are presented including a biocultural model of the interaction of trauma and ghost visitation. An extended case illustrates the article's findings.
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Affiliation(s)
- Devon E Hinton
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, 6th Floor, Boston, MA, 02114, USA.
| | - Ria Reis
- Leiden University Medical Center, Leiden, The Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
- The Children's Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Joop de Jong
- Center for Anxiety and Related Disorders, Boston University, Boston, USA
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Holliday SB, Dubowitz T, Haas A, Ghosh-Dastidar B, DeSantis A, Troxel WM. The association between discrimination and PTSD in African Americans: exploring the role of gender. Ethn Health 2020; 25:717-731. [PMID: 29490467 PMCID: PMC6113108 DOI: 10.1080/13557858.2018.1444150] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 02/19/2018] [Indexed: 06/08/2023]
Abstract
Background: Research has demonstrated the adverse impact that discrimination has on physical and mental health. However, few studies have examined the association between discrimination and symptoms of posttraumatic stress disorder (PTSD). There is evidence that African Americans experience higher rates of PTSD and are more likely to develop PTSD following trauma exposure than Whites, and discrimination may be one reason for this disparity. Purpose: To examine the association between discrimination and PTSD among a cross-sectional sample largely comprising African American women, controlling for other psychosocial stressors (psychological distress, neighborhood safety, crime). Methods: A sample of 806 participants was recruited from two low-income predominantly African American neighborhoods. Participants completed self-report measures of PTSD symptoms, perceived discrimination, perceived safety, and psychological distress. Information on neighborhood crime was obtained through data requested from the city. Multivariate linear regression models were estimated to assess adjusted relationships between PTSD symptoms and discrimination. Results: Discrimination was significantly associated with PTSD symptoms with a small effect size, controlling for relevant sociodemographic variables. This association remained consistent after controlling for psychological distress, perceived safety, and total neighborhood crime. There was no evidence of a gender by discrimination interaction. Participants who experienced any discrimination were significantly more likely to screen positive for PTSD. Conclusions: Discrimination may contribute to the disparate rates of PTSD experienced by African Americans. PTSD is associated with a range of negative consequences, including poorer physical health, mental health, and quality of life. These results suggest the importance of finding ways to promote resilience in this at-risk population.
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Affiliation(s)
| | - Tamara Dubowitz
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA
| | - Ann Haas
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA
| | | | - Amy DeSantis
- RAND Corporation, 20 Park Plaza, 9 Floor, Suite 920, Boston, MA
| | - Wendy M. Troxel
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA
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13
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Böge K, Karnouk C, Hahn E, Demir Z, Bajbouj M. On Perceived Stress and Social Support: Depressive, Anxiety and Trauma-Related Symptoms in Arabic-Speaking Refugees in Jordan and Germany. Front Public Health 2020; 8:239. [PMID: 32695739 PMCID: PMC7338673 DOI: 10.3389/fpubh.2020.00239] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 05/18/2020] [Indexed: 11/25/2022] Open
Abstract
Current literature points toward several challenges in the access to sufficient and effective psychosocial care for Syrian refugees in host settings. This study is a comparative investigation into the relationship between "perceived social stress" and "perceived social support" on three of the most prevalent symptom dimensions in Syrian refugees across two host capitals, Berlin and Amman. Eighty nine Syrians refugees were recruited between January 2017 and March 2018. Participants were contacted through local institutions and organizations collaborating with the Charité-Universitätsmedizin Berlin. Assessments include the PHQ-9, GAD-7, HTQ, MSPSS, and PSS. Primary analyses consist of non- or parametric tests and multiple linear regression analyses. Subsample analyses showed relevant depressive, anxiety and trauma-related symptoms. Significant differences in PTSD symptoms (p < 0.04) were found. Participants reported high perceived stress and moderate to high social support. Linear regressions revealed that perceived stress had a significant negative effect (p < 0.01) on clinical outcomes in both subsamples. Perceived social support had a positive influence on depressive (p = 0.02) and PTSD symptoms (p = 0.04) for participants in Berlin. Analyses revealed significant positive effects of "significant others" (p = 0.05) on depressive- in Berlin and "family" (p = 0.03) support for PTSD symptoms in Amman. Study results show that levels of "perceived stress" appear to be the same across different host countries, whereas types of social support and their effect on mental health differ significantly depending on the host setting. Outcomes may guide future comparative study designs and investigations to promote well-being, integration, and the development of effective social support structures for the diverse needs of Arabic-speaking refugees.
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Affiliation(s)
| | | | | | | | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
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14
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Last BS, Rudd BN, Gregor CA, Kratz HE, Jackson K, Berkowitz S, Zinny A, Cliggitt LP, Adams DR, Walsh LM, Beidas RS. Sociodemographic characteristics of youth in a trauma focused-cognitive behavioral therapy effectiveness trial in the city of Philadelphia. J Community Psychol 2020; 48:1273-1293. [PMID: 31872896 PMCID: PMC7261621 DOI: 10.1002/jcop.22306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/25/2019] [Accepted: 12/05/2019] [Indexed: 05/13/2023]
Abstract
While randomized controlled trials of trauma-focused cognitive behavioral therapy (TF-CBT) have demonstrated efficacy for youth with posttraumatic stress disorder, TF-CBT effectiveness trials typically show attenuated outcomes. This decrease in effectiveness may be due to the differences in sociodemographic characteristics of youth in these trials; youth in efficacy trials are more often white and middle-income, whereas youth in effectiveness trials are more often racial/ethnic minorities, of low socioeconomic status (SES) and live in high crime neighborhoods. In this study-drawn from an effectiveness trial of TF-CBT in community mental health clinics across Philadelphia-we describe the sociodemographic characteristics of enrolled youth. We measured neighborhood SES by matching participants' addresses to American Community Survey data from their Census tracts, housing stability using the National Outcomes Measurement System, and neighborhood violence using police department crime statistics. Our results suggest that the majority of youth presenting for TF-CBT in mental health clinics in the City of Philadelphia live in poor and high-crime neighborhoods, experience substantial housing instability, and are predominantly ethnic and racial minorities. Thus, youth presenting for treatment experience significant racial and socioeconomic adversity. We also explored the association between these characteristics and youth symptom severity upon presenting for treatment. These factors were not associated with youth symptom severity or overall mental health functioning in our sample (with small effect sizes and p > .05 for all). Implications for future research, such as the need for efficacy and effectiveness trials to more fully characterize their samples and the need for pragmatic trials are discussed.
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Affiliation(s)
- Briana S. Last
- Department of Psychology, School of Arts and Sciences, The University of Pennsylvania
| | - Brittany N. Rudd
- Department of Psychiatry, Perelman School of Medicine, The University of Pennsylvania
| | - Courtney A. Gregor
- Department of Psychiatry, Perelman School of Medicine, The University of Pennsylvania
| | | | | | | | | | | | | | | | - Rinad S. Beidas
- Department of Psychiatry, Perelman School of Medicine, The University of Pennsylvania
- Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania
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15
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Sundquist K, Johansson LM, DeMarinis V, Johansson SE, Sundquist J. Posttraumatic stress disorder and psychiatric co-morbidity: symptoms in a random sample of female Bosnian refugees. Eur Psychiatry 2020; 20:158-64. [PMID: 15797701 DOI: 10.1016/j.eurpsy.2004.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Accepted: 12/15/2004] [Indexed: 11/30/2022] Open
Abstract
AbstractObjectivesThis study investigated psychological symptoms in Bosnian women 3–4 years after their arrival in Sweden.MethodsA simple random sample of 163 Bosnian women aged 19–59 was drawn from the Swedish populations register in 1996. The control group consisted of 392 Swedish-born women. Data were collected in face-to-face interviews. The Hopkins Symptom Checklist 25 (HSCL-25) and the Posttraumatic Symptom Scale (PTSS-10) were used to measure psychological symptoms of depression, anxiety, psychological distress, and posttraumatic stress disorder (PTSD). Unconditional logistic regression was used to estimate odds ratios (OR) for psychological symptoms after adjustment for age, country of birth, education, marital status, economic difficulties, social network, and feeling secure.ResultsThe prevalence of symptoms of PTSD was 28.3% among the Bosnian women. Bosnian women had significantly higher risks of symptoms of depression, anxiety, and psychological distress than Swedish-born women. For depression the odds ratio was 9.50 among Bosnian women.ConclusionsPsychiatric community interventions need to target Bosnian refugee women. Awareness among health-care workers who encounter these women in a clinical setting should be improved.
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Affiliation(s)
- Kristina Sundquist
- Karolinska Institute, Department of Family Medicine, Center for Research in Migration Medicine and Psychiatry (MigraMed), Alfred Nobels allé 12, SE-141 83 Huddinge, Stockholm, Sweden.
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16
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Ogunbajo A, Anyamele C, Restar AJ, Dolezal C, Sandfort TGM. Substance Use and Depression Among Recently Migrated African Gay and Bisexual Men Living in the United States. J Immigr Minor Health 2020; 21:1224-1232. [PMID: 30552541 DOI: 10.1007/s10903-018-0849-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 02/06/2023]
Abstract
Immigrant African gay and bisexual men (GBM) are at risk for substance use and adverse mental health outcomes due to negative experiences in home and host countries. Little is known about correlates of substance use and mental health outcomes in this population. We explored pre- and post-migratory factors associated with substance use and depression in recently migrated African GBM. Participants (N = 70) were recruited between July and November 2015 in NYC. Eligible participants were administered a structured questionnaire. Correlates of substance use and depression were identified using bivariate and multivariable analyses. Factors independently associated with current substance use were age, openness about sexual orientation, homophobic experiences in home country, forced sex in home country, current housing instability, and internalized homophobia. Factors independently associated with depression were post-traumatic stress disorder symptoms and alcohol use. Substance use and depression were associated with negative experiences in home and host country.
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Affiliation(s)
- Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Chukwuemeka Anyamele
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Arjee J Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Theodorus G M Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
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17
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Sibrava NJ, Bjornsson AS, Pérez Benítez ACI, Moitra E, Weisberg RB, Keller MB. Posttraumatic stress disorder in African American and Latinx adults: Clinical course and the role of racial and ethnic discrimination. ACTA ACUST UNITED AC 2020; 74:101-116. [PMID: 30652903 DOI: 10.1037/amp0000339] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research has suggested that African American and Latinx adults may develop posttraumatic stress disorder (PTSD) at higher rates than White adults, and that the clinical course of PTSD in these minority groups is poor. Factors that may contribute to higher prevalence and poorer outcome in these groups are sociocultural factors and racial stressors, such as experiences with discrimination. To date, however, no research has explored the relationship between experiences with discrimination and risk for PTSD, and very little research has examined the course of illness for PTSD in African American and Latinx samples. The present study examined these variables in the only longitudinal clinical sample of 139 Latinx and 152 African American adults with anxiety disorders, the Harvard/Brown Anxiety Research Project-Phase II. Over 5 years of follow-up, remission rates for African Americans and Latinx adults with PTSD in this sample were 0.35 and 0.15, respectively, and reported frequency of experiences with discrimination significantly predicted PTSD diagnostic status in this sample, but did not predict any other anxiety or mood disorder. These findings demonstrate the chronic course of PTSD in African American and Latinx adults, and highlight the important role that racial and ethnic discrimination may play in the development of PTSD among these populations. Implications for an increased focus on these sociocultural stressors in the assessment and treatment of PTSD in African American and Latinx individuals are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Nicholas J Sibrava
- Department of Psychology, Baruch College, The City University of New York
| | | | | | - Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | | | - Martin B Keller
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
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18
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Nichter B, Haller M, Norman S, Pietrzak RH. Risk and protective factors associated with comorbid PTSD and depression in U.S. military veterans: Results from the National Health and Resilience in Veterans Study. J Psychiatr Res 2020; 121:56-61. [PMID: 31765837 DOI: 10.1016/j.jpsychires.2019.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 07/09/2019] [Revised: 09/30/2019] [Accepted: 11/13/2019] [Indexed: 12/17/2022]
Abstract
Converging evidence suggests that veterans with co-occurring PTSD/MDD represent a high-risk group for poor mental health compared to those with PTSD alone. To date, however, little is known about the specific factors that may increase vulnerability for and buffer risk for comorbid PTSD/MDD. The purpose of this study was to provide a population-based characterization of sociodemographic, risk, and protective variables associated with comorbid PTSD/MDD among U.S. military veterans. Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative survey of U.S. military veterans (n = 2,732). Analyses (1) compared veterans with PTSD alone and co-occurring PTSD/MDD on sociodemographic, military, and psychosocial characteristics; and (2) examined variables independently associated with PTSD/MDD status. Multivariable logistic regression analyses revealed that racial/ethnic minority status (odds ratio [OR] = 12.5), number of lifetime traumas (OR = 1.3), and time spent engaged in private religious/spiritual activities (OR = 1.8) were associated with PTSD/MDD status, while higher scores on measures of community integration (OR = 0.6) and dispositional optimism (OR = 0.7) were negatively associated with comorbid PTSD/MDD status. Relative importance analyses revealed that dispositional optimism (34%) and community integration (24%) explained the largest proportions of variance in PTSD/MDD comorbidity. Taken together, results of this study suggest that racial/ethnic minority status, greater lifetime trauma burden, and engagement in private religious/spiritual activities are key distinguishing characteristics of U.S. military veterans with comorbid PTSD/MDD vs. PTSD alone. They further underscore the need to study whether targeting community integration and optimism in prevention and treatment efforts may enhance clinical outcomes in this population.
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Affiliation(s)
- Brandon Nichter
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA.
| | - Moira Haller
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Sonya Norman
- Department of Psychiatry, University of California, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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19
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Zbidat A, Georgiadou E, Borho A, Erim Y, Morawa E. The Perceptions of Trauma, Complaints, Somatization, and Coping Strategies among Syrian Refugees in Germany-A Qualitative Study of an At-Risk Population. Int J Environ Res Public Health 2020; 17:ijerph17030693. [PMID: 31973104 PMCID: PMC7037213 DOI: 10.3390/ijerph17030693] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/09/2020] [Accepted: 01/12/2020] [Indexed: 12/21/2022]
Abstract
Background: A high prevalence of mental distress, especially posttraumatic stress disorder, has been widely confirmed among refugees. In order to establish adequate interventions in psychotherapy, however, it must first be examined whether refugees have similar ideas and concepts of stress, trauma, and healing. This study, therefore, aimed to analyze the representations of trauma, self-reported complaints, indications of somatization, and coping strategies among a refugee population. Methods: Semi-structured interviews based on the Cultural Formulation Interview (CFI) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were conducted with Syrian refugees who have residence permission in Germany. The interviews were audio-recorded, transcribed, and analyzed according to the qualitative content analysis of Mayring. The foci of interest were determined on the basis of the predefined interview guideline, and inductive subcategories were extracted from the transcripts. Results: Sixteen refugees participated (50% women; mean age: 35.5 years, SD = 11.2; the mean duration of stay in Germany: 23.3 months, SD = 6.6). War experiences were the most frequently reported subjective perceptions of trauma. Frequently reported complaints included sleeping disturbance, cardiovascular symptoms, rumination, and pain. Among half of the participants, we found indications of somatization. We identified the following coping strategies: Activity, cognitive coping, social coping, religious coping, avoidance, and emotional coping. Conclusions: War-related traumatic events are the most common trauma perceptions among Syrian refugees. The self-reported complaints demonstrate somatoform, depressive, and posttraumatic symptoms. Syrian refugees should be screened for somatization, depression, and posttraumatic stress disorder and should receive targeted interventions that consider and support individual coping resources.
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Affiliation(s)
- Ali Zbidat
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.Z.); (E.G.); (A.B.); (Y.E.)
| | - Ekaterini Georgiadou
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.Z.); (E.G.); (A.B.); (Y.E.)
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, 90419 Nürnberg, Germany
| | - Andrea Borho
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.Z.); (E.G.); (A.B.); (Y.E.)
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.Z.); (E.G.); (A.B.); (Y.E.)
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.Z.); (E.G.); (A.B.); (Y.E.)
- Correspondence:
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Snijders C, Maihofer AX, Ratanatharathorn A, Baker DG, Boks MP, Geuze E, Jain S, Kessler RC, Pishva E, Risbrough VB, Stein MB, Ursano RJ, Vermetten E, Vinkers CH, Smith AK, Uddin M, Rutten BPF, Nievergelt CM. Longitudinal epigenome-wide association studies of three male military cohorts reveal multiple CpG sites associated with post-traumatic stress disorder. Clin Epigenetics 2020; 12:11. [PMID: 31931860 PMCID: PMC6958602 DOI: 10.1186/s13148-019-0798-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 09/24/2019] [Accepted: 12/19/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Epigenetic mechanisms have been suggested to play a role in the development of post-traumatic stress disorder (PTSD). Here, blood-derived DNA methylation data (HumanMethylation450 BeadChip) collected prior to and following combat exposure in three cohorts of male military members were analyzed to assess whether DNA methylation profiles are associated with the development of PTSD. A total of 123 PTSD cases and 143 trauma-exposed controls were included in the analyses. The Psychiatric Genomics Consortium (PGC) PTSD EWAS QC pipeline was used on all cohorts, and results were combined using a sample size weighted meta-analysis in a two-stage design. In stage one, we jointly analyzed data of two new cohorts (N = 126 and 78) for gene discovery, and sought to replicate significant findings in a third, previously published cohort (N = 62) to assess the robustness of our results. In stage 2, we aimed at maximizing power for gene discovery by combining all three cohorts in a meta-analysis. RESULTS Stage 1 analyses identified four CpG sites in which, conditional on pre-deployment DNA methylation, post-deployment DNA methylation was significantly associated with PTSD status after epigenome-wide adjustment for multiple comparisons. The most significant (intergenic) CpG cg05656210 (p = 1.0 × 10-08) was located on 5q31 and significantly replicated in the third cohort. In addition, 19 differentially methylated regions (DMRs) were identified, but failed replication. Stage 2 analyses identified three epigenome-wide significant CpGs, the intergenic CpG cg05656210 and two additional CpGs located in MAD1L1 (cg12169700) and HEXDC (cg20756026). Interestingly, cg12169700 had an underlying single nucleotide polymorphism (SNP) which was located within the same LD block as a recently identified PTSD-associated SNP in MAD1L1. Stage 2 analyses further identified 12 significant differential methylated regions (DMRs), 1 of which was located in MAD1L1 and 4 were situated in the human leukocyte antigen (HLA) region. CONCLUSIONS This study suggests that the development of combat-related PTSD is associated with distinct methylation patterns in several genomic positions and regions. Our most prominent findings suggest the involvement of the immune system through the HLA region and HEXDC, and MAD1L1 which was previously associated with PTSD.
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Affiliation(s)
- Clara Snijders
- Department of Psychiatry and Neuropsychology, School for Mental health and Neuroscience, Maastricht University, Maastricht, Limburg, Netherlands
| | - Adam X Maihofer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | | | - Dewleen G Baker
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Psychiatry Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Marco P Boks
- Department of Psychiatry, UMC Utrecht Brain Center, Utrecht, Utrecht, Netherlands
| | - Elbert Geuze
- Department of Psychiatry, UMC Utrecht Brain Center, Utrecht, Utrecht, Netherlands
- Brain Research & Innovation Centre, Netherlands Ministry of Defense, Utrecht, Utrecht, Netherlands
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ehsan Pishva
- Department of Psychiatry and Neuropsychology, School for Mental health and Neuroscience, Maastricht University, Maastricht, Limburg, Netherlands
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Victoria B Risbrough
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Psychiatry Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Million Veteran Program, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Robert J Ursano
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA
| | - Eric Vermetten
- Arq, Psychotrauma Research Expert Group, Diemen, North Holland, Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, South Holland, Netherlands
- Military Mental Healthcare, Netherlands Ministry of Defense, Utrecht, Utrecht, Netherlands
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Christiaan H Vinkers
- Department of Anatomy and Neurosciences, Amsterdam UMC (location VUmc), Amsterdam, Holland, Netherlands
- Department of Psychiatry, Amsterdam UMC (location VUmc), Amsterdam, Holland, Netherlands
| | - Alicia K Smith
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Monica Uddin
- Genomics Program, University of South Florida College of Public Health, Tampa, FL, USA
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental health and Neuroscience, Maastricht University, Maastricht, Limburg, Netherlands
| | - Caroline M Nievergelt
- Department of Psychiatry and Neuropsychology, School for Mental health and Neuroscience, Maastricht University, Maastricht, Limburg, Netherlands.
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
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Downing MJ, Benoit E, Brown D, Coe L, Hirshfield S, Pansulla L, Carballo-Diéguez A. Early Sexual Experiences, Mental Health, and Risk Behavior among Black Non-Hispanic and Hispanic / Latino Men Who Have Sex with Men (MSM). J Child Sex Abus 2020; 29:41-61. [PMID: 31697197 PMCID: PMC7035177 DOI: 10.1080/10538712.2019.1685618] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 05/31/2023]
Abstract
Black and Latino men who have sex with men (MSM) are disproportionately affected by childhood sexual abuse (CSA). Investigating these histories is often confounded by underreporting and varied definitions of abuse. Unrecognized abuse may manifest in unhealthy ways, specifically psychological distress, substance use, and high-risk sexual behaviors. Black and Hispanic/Latino MSM in New York City discussed formative sexual experiences in in-person interviews. Eligible men reported a sexual experience occurring before age 16 with a man or woman 18 or older at the time. Among interviewees (n = 61), men living with HIV were significantly younger at the time of their first sexual experience with a male partner compared to HIV-negative men. Approximately half of interviewees (47.5%) scored at or above the diagnostic cutoff for post-traumatic stress disorder (PTSD). Hispanic/Latino men had increased odds of scoring at or above the diagnostic cutoff for PTSD compared to Black non-Hispanic men. Further, nearly half of interviewees (46%) scored at or above the diagnostic cutoff for harmful drug use or possible drug dependence. Study findings have implications for future research using an indirect approach to uncovering potential sexual abuse during childhood, and associations with adult health outcomes.
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Affiliation(s)
- Martin J Downing
- Department of Psychology, Lehman College of the City University of New York (CUNY), Bronx, NY, USA
| | - Ellen Benoit
- North Jersey Community Research Initiative, Inc., Newark, NJ, USA
| | - Dominique Brown
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Lauren Coe
- New York City Department of Education, New York, NY, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Louis Pansulla
- The Institute for Clinical Social Work, Chicago, IL, USA
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22
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Vásquez D, Ponte L, Andrews AR, Garcia E, Terrazas-Carrillo E, Ojeda L, de Arrellano MA. Más allá de las barreras: Competency and practice considerations in language, cultural, and social issues when delivering group CPT to Hispanic immigrants. Int J Group Psychother 2019; 70:212-243. [PMID: 32616960 PMCID: PMC7332161 DOI: 10.1080/00207284.2019.1677469] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
High rates of under-assessed trauma and psychiatric disorders, particularly posttraumatic stress disorder (PTSD) have been reported among Hispanic immigrants, especially as related to immigration trauma. Multiple studies have shown group cognitive processing therapy (CPT) to be an effective evidence-based practice (EBP) for treatment of PTSD across a number of clinical populations. To date, however, no studies have examined important competency and practice issues in linguistic, cultural, and ethical areas that group CPT providers should consider when delivering group CPT to Hispanic immigrants. This paper aims to outline these and provide future directions for research.
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Valentine SE, Marques L, Wang Y, Ahles EM, Dixon De Silva L, Alegría M. Gender differences in exposure to potentially traumatic events and diagnosis of posttraumatic stress disorder (PTSD) by racial and ethnic group. Gen Hosp Psychiatry 2019; 61:60-68. [PMID: 31715388 PMCID: PMC6870874 DOI: 10.1016/j.genhosppsych.2019.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Received: 04/01/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is a robust literature base documenting gender differences and racial/ethnic differences in exposure to potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) diagnosis. Yet, to the best of our knowledge, this is the first study to evaluate the risk of PTEs and PTSD between genders, stratified by race/ethnicity. We aimed to better understand whether factors associated with poor psychological adjustment following PTEs (e.g., PTE type, sociodemographic factors, social support) varied by gender and race/ethnicity. METHOD Data were collected from three U.S.-based national studies comprising the Collaborative Psychiatric Epidemiologic Surveys (CPES; N = 13,649). Trained lay interviewers administered questionnaires and collected data on PTE exposure, PTSD, and psychosocial covariates. Regression analyses were conducted to investigate relations between PTEs, PTSD, and gender, stratified by race/ethnicity. RESULTS Adjusting for sociodemographic variables, mental health comorbidity, social support, and PTE frequency, White, African-American, and Afro-Caribbean women had higher odds of PTSD than men in their respective racial/ethnic groups, whereas gender differences were not observed for Latinos or Asians. CONCLUSION Findings suggest that risk of exposure to PTEs and PTSD may differ by gender and race/ethnicity. Future studies should consider the contributions of social, cultural, and contextual factors in estimating PTSD risk.
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Affiliation(s)
- Sarah E Valentine
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America; Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America.
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Ye Wang
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Emily M Ahles
- College of Applied Behavioral Sciences, University of Indianapolis, Indianapolis, IN, United States of America
| | - Louise Dixon De Silva
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Margarita Alegría
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
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24
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Nikulina V, Bautista A, Brown EJ. Negative Responses to Disclosure of Sexual Victimization and Victims' Symptoms of PTSD and Depression: The Protective Role of Ethnic Identity. J Interpers Violence 2019; 34:4638-4660. [PMID: 27815326 DOI: 10.1177/0886260516676475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
College-aged women experience high rates of sexual victimization. Their postassault symptoms are associated with the types of responses they receive from the people to whom they disclose these experiences. Negative responses are pervasive and associated with poorer outcomes. The current study examined whether a strong sense of ethnic identity and comfort with the mainstream culture moderate the association between negative responses to the first disclosure of sexual victimization and symptoms of posttraumatic stress disorder (PTSD) and depression. A diverse sample (10% Black/African American, 51% White, 39% Other, and 66% Hispanic) of undergraduate women was recruited from two urban, Eastern United States universities for this online study. Participants reported histories of sexual victimization, demographics, responses to sexual assault disclosure (i.e., victim blame, treating the victim differently, taking control, distraction, and egocentric reactions), symptoms of PTSD and depression, and their ethnic identity and mainstream cultural comfort. Thirty-seven percent (n = 221) endorsed an experience of sexual victimization, and 165 disclosed it to someone. Hierarchical ordinary least squares regressions revealed that a stronger sense of ethnic identity was associated with fewer symptoms of PTSD for those women who experienced higher levels of control, distraction, and egocentric responses from the first disclosure recipient. A strong sense of affiliation with the mainstream culture did not protect survivors who reported receiving negative responses to disclosure against symptoms of PTSD or depression. Ethnic affiliation may protect women against PTSD when they receive high levels of negative messages about sexual victimization experiences.
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Affiliation(s)
- Valentina Nikulina
- Queens College, City University of New York, Flushing, NY, USA
- The Graduate Center, City University of New York, New York, NY, USA
| | - Adrian Bautista
- Queens College, City University of New York, Flushing, NY, USA
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Kaltman S, Watson MR, Campoli M, Serrano A, Talisman N, Kirkpatrick L, Mete M, Green BL. Treatment of depression and PTSD in primary care clinics serving uninsured low-income mostly Latina/o immigrants: A naturalistic prospective evaluation. Cultur Divers Ethnic Minor Psychol 2019; 25:579-589. [PMID: 30816751 PMCID: PMC6713614 DOI: 10.1037/cdp0000251] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Uninsured immigrants to the United States are psychologically vulnerable due to limited access to mental health services. Latina/o immigrants from Central and South America are further at risk due to high levels of trauma exposure, both in their country of origin and their adopted country. Effective behavioral interventions in primary care are needed to address this services gap for common trauma-related mental disorders, including depression and posttraumatic stress disorder (PTSD). A naturalistic prospective study compared depression and PTSD outcomes for uninsured primary care patients, mostly Latina/o immigrants, in clinics with distinct models for integrating behavioral health services. One clinic had a collaborative care program, that is, a multicomponent, system-level intervention with the goals of facilitating increased screening, improving diagnostic accuracy, increasing uptake of evidence-based treatment, and utilizing measurement-based treatment to target. The other had colocated services, with an on-site therapist. METHOD One hundred thirty-eight patients with presumptive depression were interviewed at baseline. Follow-up data were collected 8 months later. Care received between the two assessments was ascertained by chart review. RESULTS There was a significant decrease in depression symptoms regardless of clinic. Factors associated with improved depression outcomes included absence of comorbid PTSD and lack of additional trauma exposures. Although there was overall improvement in PTSD, there was significantly more improvement in the collaborative care clinic. CONCLUSIONS Results suggest that both models were effective for depression and PTSD; however, the collaborative care model had added benefits for those patients with PTSD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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M'zah S, Lopes Cardozo B, Evans DP. Mental Health Status and Service Assessment for Adult Syrian Refugees Resettled in Metropolitan Atlanta: A Cross-Sectional Survey. J Immigr Minor Health 2019; 21:1019-1025. [PMID: 30109534 PMCID: PMC6375803 DOI: 10.1007/s10903-018-0806-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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] [Indexed: 10/28/2022]
Abstract
Because little is known about the mental health status of Syrian refugees in the United States, we conducted a survey among a convenience sample of those resettled in Atlanta between March 2011 and 2017. Though home visits, we delivered a questionnaire including standardized instruments (HSCL25 and PTSD-8) to assess symptoms of anxiety, depression and Posttraumatic Stress Disorder. We found high rates of anxiety (60%), depression (44%) and Posttraumatic Stress Disorder (84%) symptoms; however, only 20% of participants had seen a mental health professional. Reported reasons for not seeking professional help were lack of transportation and access to information. Findings of this survey indicate the high burden of mental health symptoms and the need for services to the study population. A longitudinal study with a larger sample size would improve the understanding of mental health needs and resilience factors of Syrian refugees resettled in the US.
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Affiliation(s)
- Skander M'zah
- Center for Humanitarian Emergencies, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- , Tunis, Tunisia.
| | - Barbara Lopes Cardozo
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dabney P Evans
- Center for Humanitarian Emergencies, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Jurcik T, Sunohara M, Yakobov E, Solopieiva-Jurcikova I, Ahmed R, Ryder AG. Acculturation and adjustment of migrants reporting trauma: The contextual effects of perceived ethnic density. J Community Psychol 2019; 47:1313-1328. [PMID: 30981217 DOI: 10.1002/jcop.22183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/30/2018] [Accepted: 02/19/2019] [Indexed: 06/09/2023]
Abstract
Little is known about the relation between acculturation and socioecological contexts of migrants with a personal trauma history living in the community. This study represents an extension of our previous work and aimed to unpack the perceived neighborhood ethnic density (ED) effect and examine the moderating role of ED on the acculturation-adjustment relation in a community sample of migrants with trauma (N = 99) from developing countries residing in Montreal, Canada. ED was protective against general psychological distress but did not predict posttraumatic symptoms. The ED effect was mediated via degree of acculturation to the French-Canadian mainstream cultural context, rather than heritage acculturation, social support, or discrimination. Moreover, protective effects of French-Canadian mainstream acculturation for depressive symptoms and life satisfaction were found under high but not low ED conditions. Similarities and differences with our previous research as well as theoretical and prevention implications are discussed from a person-environment interaction perspective.
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Affiliation(s)
- Tomas Jurcik
- Department of Psychology, National Research University-Higher School of Economics, Moscow, Russia
| | - Momoka Sunohara
- Department of Psychology, Concordia University, Montreal, Canada
| | - Esther Yakobov
- Department of Psychology, McGill University, Montreal, Canada
| | | | - Rana Ahmed
- School of Social Work, McGill University, Montreal, Canada
| | - Andrew G Ryder
- Department of Psychology, Concordia University, Montreal, Canada
- Sir Mortimer B. Davis Jewish General Hospital, Montreal, Canada
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Leiler A, Bjärtå A, Ekdahl J, Wasteson E. Mental health and quality of life among asylum seekers and refugees living in refugee housing facilities in Sweden. Soc Psychiatry Psychiatr Epidemiol 2019; 54:543-551. [PMID: 30580381 DOI: 10.1007/s00127-018-1651-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [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: 05/18/2018] [Accepted: 12/12/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In 2015, there was a high influx of refugees to Sweden, creating an extreme situation where individuals were forced to remain in large housing facilities for long periods. The present study aims to describe the mental health and quality of life of these individuals. METHODS Data, based on 510 individuals, were obtained by means of a questionnaire at open screenings conducted at or nearby refugee housing facilities. Of the participating refugees, 367 were asylum seekers and 143 had received a residence permit but were still awaiting a more permanent housing solution. The questionnaire included measures of depressive symptoms (PHQ-9), symptoms of anxiety (GAD-7), risk of having post-traumatic stress disorder (PC-PTSD), and quality of life (WHOQOL-BREF). RESULTS Of the total sample, 56-58.4% reported clinically significant levels of symptoms of depression, anxiety and risk of having PTSD. Prevalence estimates were higher among asylum seekers than among those who had received their residence permit. Quality of life was generally rated below population norms and correlated negatively with mental health outcomes. CONCLUSIONS Individuals residing in refugee housing facilities show high levels of psychological distress and rate their quality of life as low. Asylum seekers score higher than those having received a residence permit. These results are troublesome since the wait time for asylum decisions has lengthened considerably after 2015. The results of the present study calls for the urgency of societal actions to shorten the asylum process and improve conditions at the housing facilities.
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Affiliation(s)
- Anna Leiler
- Department of Psychology, Mid Sweden University, 831 25, Östersund, Sweden.
| | - Anna Bjärtå
- Department of Psychology, Mid Sweden University, 831 25, Östersund, Sweden
| | - Johanna Ekdahl
- Department of Psychology, Mid Sweden University, 831 25, Östersund, Sweden
| | - Elisabet Wasteson
- Department of Psychology, Mid Sweden University, 831 25, Östersund, Sweden
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Abstract
Immigration comes with rapid changes in social status that have effects on mental health. Research with nonimmigrant populations has identified relevant social status indicators, but these indicators are not sufficient to address changes that are uniquely relevant to immigrants. This study aimed to identify social status indicators that change during the process of migration and to examine their association with distress using variable- and person-centered analyses. We used data from an archival dataset of West African immigrants in New York City. Pre- and postmigration changes across work, marriage, language use, urbanism, and residency status were used to assess whether positive, negative, or no change in social status had occurred. Changes in social status indicators across migration were predicted to account for variance in mental health outcomes (i.e., anxiety, depression, somatization, and posttraumatic stress) beyond premigration potentially traumatic events (PTE). Several social status indicators predicted wellbeing in this population and accounted for variance in distress beyond premigration PTEs. Ward's method clustering suggested that 3 distinct social status profiles were characterized primarily by changes in work and marriage. The cluster with the greatest positive changes in work was almost all female and had the highest depression scores. These findings suggest that the impact of change in social status across immigration is not uniform across social status indicators. Additionally, changing gender roles across migration appear to have an influential impact on postmigration social status and mental health. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Sagal Ahmed
- Department of Psychology, Fordham University
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30
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Lenane Z, Peacock E, Joyce C, Frohlich ED, Re RN, Muntner P, Krousel-Wood M. Association of Post-Traumatic Stress Disorder Symptoms Following Hurricane Katrina With Incident Cardiovascular Disease Events Among Older Adults With Hypertension. Am J Geriatr Psychiatry 2019; 27:310-321. [PMID: 30581139 PMCID: PMC6476543 DOI: 10.1016/j.jagp.2018.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Received: 05/24/2018] [Revised: 10/10/2018] [Accepted: 11/22/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the association of post-traumatic stress disorder (PTSD) symptoms following Hurricane Katrina with incident cardiovascular disease (CVD) events in older, hypertensive, community-dwelling adults both overall and stratified by age, sex, and race. METHODS This was a prospective cohort study performed in Southeastern Louisiana 12-24 months following Hurricane Katrina through February 2011. Participants were community-dwelling older adults (n = 2,073) enrolled in the Cohort Study of Medication Adherence Among Older Adults with no known history of CVD events. PTSD symptoms were assessed via telephone interview 12-24 months following Hurricane Katrina using the PTSD CheckList-Specific Version. The presence of PTSD symptoms was defined by scores greater than or equal to 37. Incident CVD events (stroke, myocardial infarction, hospitalization for congestive heart failure, or CVD death) were identified and adjudicated over a median 3.8-year follow-up period. RESULTS Overall, 8.6% of participants screened positive for PTSD symptoms, and 11.6% had an incident CVD event during follow-up. PTSD symptoms were associated with an adjusted hazard ratio (aHR) for CVD events of 1.7 (95% confidence interval [CI], 1.1, 2.6). The association was present among blacks (aHR, 3.3, 95% CI, 1.7, 6.3) but not whites (aHR, 0.9, 95% CI, 0.4, 1.9); the interaction of PTSD symptoms and race on CVD events was statistically significant. CONCLUSION PTSD symptoms following Hurricane Katrina were associated with a higher risk of incident CVD in older adults with hypertension, with a stronger association in blacks compared with whites.
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Affiliation(s)
- Zachary Lenane
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Erin Peacock
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Cara Joyce
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Edward D Frohlich
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Richard N Re
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Paul Muntner
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Marie Krousel-Wood
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL.
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Khan MN, Hamdani SU, Chiumento A, Dawson K, Bryant RA, Sijbrandij M, Nazir H, Akhtar P, Masood A, Wang D, Wang E, Uddin I, van Ommeren M, Rahman A. Evaluating feasibility and acceptability of a group WHO trans-diagnostic intervention for women with common mental disorders in rural Pakistan: a cluster randomised controlled feasibility trial. Epidemiol Psychiatr Sci 2019; 28:77-87. [PMID: 28689511 PMCID: PMC6998939 DOI: 10.1017/s2045796017000336] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/09/2017] [Indexed: 11/07/2022] Open
Abstract
AIMS The aim of this feasibility trial was to evaluate the feasibility and acceptability of the locally adapted Group Problem Management Plus (PM+) intervention for women in the conflict affected settings in Swat, Pakistan. METHODS This mixed-methods study incorporated a quantitative component consisting of a two arm cluster randomised controlled feasibility trial, and qualitative evaluation of the acceptability of the Group PM+ to a range of stakeholder groups. For the quantitative component, on average from each of the 20 Lady Health Workers (LHWs) catchment area (20 clusters), six women were screened and recruited for the trial with score of >2 on the General Health Questionnaire and score of >16 on the WHO Disability Assessment Schedule. These LHW clusters were randomised on a 1 : 1 allocation ratio using a computer-based software through a simple randomisation method to the Group PM+ intervention or Enhanced Usual Care. The Group PM+ intervention consisted of five weekly sessions of 2 h duration delivered by local non-specialist females under supervision. The primary outcome was individual psychological distress, measured by levels of anxiety and depression on the Hospital Anxiety and Depression Scale at 7th week after baseline. Secondary outcomes include symptoms of depression, post-traumatic stress disorder (PTSD), general psychological profile, levels of functioning and generalised psychological distress. Intervention acceptability was explored through in-depth interviews. RESULTS The results show that lay-helpers with no prior mental health experience can be trained to achieve the desired competency to successfully deliver the intervention in community settings under supervision. There was a good intervention uptake, with Group PM+ considered useful by participants, their families and lay-helpers. The outcome evaluation, which was not based on a large enough study to identify statistically significant results, indicated statistically significant improvements in depression, anxiety, general psychological profile and functioning. The PTSD symptoms and depressive disorder scores showed a trend in favour of the intervention. CONCLUSION This trial showed robust acceptance in the local settings with delivery by non-specialists under supervision by local trained females. The trial paves the way for further adaptation and exploration of the outcomes through larger-scale implementation and definitive randomised controlled trials in the local settings.
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Affiliation(s)
- M. N. Khan
- Khyber Medical University, Institute of Public Health & Social Sciences (IPH&SS), 10-B, Near ICMS, Phase V, Hayatabad, Peshawar, Pakistan
| | - S. U. Hamdani
- Human Development Research Foundation, Islamabad, Pakistan
- University of Liverpool, Liverpool, UK
| | | | - K. Dawson
- University of New South Wales, Sydney, Australia
| | - R. A. Bryant
- University of New South Wales, Sydney, Australia
| | | | - H. Nazir
- Human Development Research Foundation, Islamabad, Pakistan
| | - P. Akhtar
- Human Development Research Foundation, Islamabad, Pakistan
| | - A. Masood
- Human Development Research Foundation, Islamabad, Pakistan
| | - D. Wang
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - E. Wang
- Queen Mary University of London, UK
| | - I. Uddin
- Bacha Khan Medical College, Mardan, Pakistan
| | - M. van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland
| | - A. Rahman
- Human Development Research Foundation, Islamabad, Pakistan
- University of Liverpool, Liverpool, UK
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Erving CL, Thomas CS, Frazier C. Is the Black-White Mental Health Paradox Consistent Across Gender and Psychiatric Disorders? Am J Epidemiol 2019; 188:314-322. [PMID: 30358803 PMCID: PMC6357792 DOI: 10.1093/aje/kwy224] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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: 03/05/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 11/12/2022] Open
Abstract
This study assessed whether the black-white mental health epidemiologic paradox (i.e., blacks' lower or similar rates of mental disorder relative to whites) extends across 12 lifetime and past-year psychiatric disorders and whether it varies with gender. We used data from the National Comorbidity Survey Replication and the National Survey of American Life, 2001-2003 (n = 4,584 black and 6,668 non-Hispanic white persons). Results showed overwhelming evidence of the paradox across lifetime and past-year disorders for women and men. In addition, blacks' mental health advantage over whites widened after adjusting for socioeconomic factors. There was one exception: Black women experienced higher risk of lifetime posttraumatic stress disorder compared with white women. These findings provide strong evidence for the "black-white mental health paradox"; however, additional research is needed to understand black women's heightened risk for posttraumatic stress disorder.
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Affiliation(s)
- Christy L Erving
- Department of Sociology, Vanderbilt University, Nashville, Tennessee
| | - Courtney S Thomas
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Cleothia Frazier
- Department of Sociology, Vanderbilt University, Nashville, Tennessee
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Getnet B, Medhin G, Alem A. Symptoms of post-traumatic stress disorder and depression among Eritrean refugees in Ethiopia: identifying direct, meditating and moderating predictors from path analysis. BMJ Open 2019; 9:e021142. [PMID: 30659034 PMCID: PMC6340455 DOI: 10.1136/bmjopen-2017-021142] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This study aimed at testing the significance of mediating and moderating roles of sense of coherence, adaptive coping styles and social support in the relationship between exposure to trauma and psychological symptoms in a refugee population in sub-Saharan Africa. METHODS A cross-sectional survey design was employed to collect data. The study was carried out in Mai Aini refugee camp in Ethiopia. A total of 562 adult Eritrean refugees aged 18-74 years were selected randomly to screen for depression and post-traumatic stress disorder (PTSD) symptoms and to examine associated factors. Data were collected using the premigration and postmigration living difficulties checklist, Center for Epidemiologic Studies Depression (CES-D) scale, Primary Care PTSD Screener, coping style scale, Sense of Coherence scale and Oslo Social Support scale. Path modelling was used to test the mediation and moderation effects of prespecified factors. RESULTS Premigration living difficulties were associated directly with symptoms of PTSD (β=0.09, p<0.05), and associated indirectly with PTSD symptoms in paths through duration of stay in the camp, sense of coherence, postmigration living difficulties, task-oriented coping style and depressive symptoms (β=0.26, p<0.01). Premigration and postmigration living difficulties were associated directly with depressive symptoms with standardised estimate of β=0.35(p<0.001) and β=0.23(p<0.05), respectively. Postmigration living difficulties were associated indirectly with PTSD through paths of sense of coherence, task-oriented coping style and depressive symptoms (β=0.13; p<0.01). Social support moderated the effect of postmigration living difficulties on depressive symptoms (p<0.05). Emotion-oriented coping style moderated the effect of premigration threat for abuse on PTSD (β=-0.18, p<0.001) and depressive (β=-0.12, p<0.01) symptoms, as well as moderating threat to life on PTSD symptoms (β=-0.13, p<0.001). CONCLUSIONS Sense of coherence and task-oriented coping style showed a partial mediating effect on the association between exposure to trauma and symptoms of PTSD. An emotion-oriented coping style and social support moderated the effect of premigration and postmigration living difficulties, respectively. Fostering social support, task-oriented and emotion-oriented coping styles may be beneficial for these refugees.
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Affiliation(s)
- Berhanie Getnet
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychology, University of Gondar, Gondar, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Alem
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Bonilla-Escobar FJ, Fandiño-Losada A, Martínez-Buitrago DM, Santaella-Tenorio J, Tobón-García D, Muñoz-Morales EJ, Escobar-Roldán ID, Babcock L, Duarte-Davidson E, Bass JK, Murray LK, Dorsey S, Gutierrez-Martinez MI, Bolton P. A randomized controlled trial of a transdiagnostic cognitive-behavioral intervention for Afro-descendants' survivors of systemic violence in Colombia. PLoS One 2018; 13:e0208483. [PMID: 30532155 PMCID: PMC6287825 DOI: 10.1371/journal.pone.0208483] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 11/19/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Exposure to violence has negative consequences on mental health. Armed-conflict in Colombia has widely affected Afro-descendants in the Pacific region. Evidence regarding effectiveness of mental health interventions is lacking in low-income settings, especially in areas with active conflict. The objective of this study is to evaluate an individualized Common Elements Treatment Approach (CETA), a transdiagnostic psychotherapy model based on Cognitive-Behavioral Therapy, for adult trauma survivors. METHODS AND FINDINGS A referred sample of 521 adult Afro-descendants from Buenaventura and Quibdó, Colombia, experiencing significant sadness, suffering or fear (score>0.77 in Total Mental Health Symptoms), with history of traumatic experiences, and with associated functional impairment were randomly allocated to CETA intervention, standby group without intervention, but under monthly monitoring, or a Narrative Community-Based Group Therapy. CETA was provided by trained Lay Psychosocial Community Workers without previous mental health experience, supervised by psychologists, during 12-14 weekly, 1.5-hour sessions. Symptoms were assessed with a locally validated survey built based on the Hopkins Symptom Checklist, the Harvard Trauma Questionnaire, the PTSD CheckList-Civilian Version, a qualitative study for additional general symptoms and a gender-specific functional impairment scale. CETA was compared with the control group and the intervention effects were calculated with mixed models using intention to treat analysis. Participant completion of follow-up was 75.1% and 13.2% voluntarily withdrew. Reduction in post-traumatic stress symptoms was significant in both municipalities when comparing intervention and control groups (mean difference), with a with a moderate effect size in Buenaventura (Cohen's d = 0.70) and a small effect size in Quibdó (d = 0.31). In Buenaventura, the intervention also had significant effects on depression (large effect size d = 1.03), anxiety (large effect size d = 0.80) and functional impairment (moderate effect size d = 0.70). In Quibdó, it had no significant effect on these outcomes. Changes in Total Mental Health Symptoms were not significant in neither city. CONCLUSIONS This trial suggests that CETA, can be effective in improving depression, anxiety, post-traumatic stress and function among victims of systematized violence in low-income and active conflict settings. Nonetheless, the difference of effectiveness between the two cities of intervention may indicate that we cannot assume that a mental health intervention known to be effective in one setting will be effective in another, even in similar circumstances and population. This may have special importance when implementing and reproducing these types of intervention in non-controlled circumstances. Further research should address these concerns. Results can be of use by governmental decision-makers when defining mental health programs for survivors. TRIAL REGISTRATION ClinicalTrials.gov NCT01856673 (https://clinicaltrials.gov/ct2/show/NCT01856673).
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Affiliation(s)
- Francisco J. Bonilla-Escobar
- Instituto CISALVA, Universidad del Valle, Cali, Colombia
- Institute for Clinical Research Education, University of Pittsburgh, Pittsburgh, PA, United States of America
- SCISCO Foundation, Cali, Colombia
- * E-mail: ,
| | - Andrés Fandiño-Losada
- Instituto CISALVA, Universidad del Valle, Cali, Colombia
- Public Health School, Universidad del Valle, Cali, Colombia
| | | | - Julián Santaella-Tenorio
- Instituto CISALVA, Universidad del Valle, Cali, Colombia
- Epidemiology Department, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | | | - Edgar J. Muñoz-Morales
- Instituto CISALVA, Universidad del Valle, Cali, Colombia
- Public Health School, Universidad del Valle, Cali, Colombia
| | - Ivan D. Escobar-Roldán
- Instituto CISALVA, Universidad del Valle, Cali, Colombia
- Psychiatry Residency Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Lori Babcock
- Heartland Alliance International, Chicago, IL, United States of America
| | | | - Judith K. Bass
- Department of International Health and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Laura K. Murray
- Department of International Health and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Shannon Dorsey
- Department of Psychology, University of Washington. Seattle, WA, United States of America
| | - Maria I. Gutierrez-Martinez
- Instituto CISALVA, Universidad del Valle, Cali, Colombia
- Public Health School, Universidad del Valle, Cali, Colombia
| | - Paul Bolton
- Department of International Health and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
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Abstract
Black women living with HIV/AIDS (LWHA) are a subgroup with the highest growing rates of HIV infection in the United States. Stigma and co-occurring mental and physical health problems have been reported among Black women LWHA, and research on the benefits of social and religious support, often major protective factors among Black women, has been met with mixed findings. The current study examined the relation between anticipated HIV stigma and mental and physical health symptoms and risk and protective factors (discrimination, coping, social support) among Black women LWHA (N = 220). Results showed that greater anticipated stigma was significantly related to poorer mental health status, greater discrimination, and greater use of negative coping strategies. Stigma was not related to physical health, perceived social support or use of positive coping strategies. This study lends support to the need for psychosocial interventions that reduce anticipated stigma among individuals LWHA, particularly Black women LWHA.
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Affiliation(s)
- Letitia E Travaglini
- VA Capital Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), 10 N. Greene St., Annex Building, 7th Floor, Baltimore, MD, 21201, USA.
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| | - Seth S Himelhoch
- Department of Psychiatry, University of Kentucky College of Medicine, Lexington, KY, 40509, USA
| | - Li Juan Fang
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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Kung WW, Liu X, Goldmann E, Huang D, Wang X, Kim K, Kim P, Yang LH. Posttraumatic stress disorder in the short and medium term following the World Trade Center attack among Asian Americans. J Community Psychol 2018; 46:1075-1091. [PMID: 30311973 PMCID: PMC6365301 DOI: 10.1002/jcop.22092] [Citation(s) in RCA: 6] [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] [Received: 09/30/2017] [Revised: 02/06/2018] [Accepted: 03/22/2018] [Indexed: 06/08/2023]
Abstract
This study investigated patterns of probable posttraumatic stress disorder (PTSD) and their predictors among 2,431 Asian American and 31,455 non-Hispanic White World Trade Center (WTC) Registry participants 2-3 years and 5-6 years after the WTC attack. Participants were divided into four PTSD pattern groups: resilient, remitted, delayed onset, and chronic. Asians had a lower proportion in the resilient group (76.5% vs. 79.8%), a higher proportion in the chronic (8.6% vs. 7.4%) and remitted (5.9% vs. 3.4%) groups, and a similar proportion in the delayed onset group (about 9%) compared to Whites. In multinomial logistic regression analyses, disaster exposure, immigrant status, lower income, pre-attack depression/anxiety, and lower respiratory symptoms were associated with increased odds of chronic and delayed onset PTSD (vs. resilience) among both races. Education and employment were protective against chronic and delayed onset PTSD among Whites only. These results can inform targeted outreach efforts to enhance prevention and treatment for Asians affected by future events.
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Loeb TB, Joseph NT, Wyatt GE, Zhang M, Chin D, Thames A, Aswad Y. Predictors of somatic symptom severity: The role of cumulative history of trauma and adversity in a diverse community sample. Psychol Trauma 2018; 10:491-498. [PMID: 29154595 PMCID: PMC6021222 DOI: 10.1037/tra0000334] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Somatic symptoms are often reported among victims of trauma, and place a significant burden on primary care health providers. We examined the relationship between lifetime histories of trauma and adversity, including aspects not previously studied (i.e., perceived discrimination), and somatic symptoms, as well as the mediating role of posttraumatic stress symptoms (PTSS) and depressive symptoms. METHOD A multiethnic community sample of 500 male and female participants (230 African American and 270 Latino) completed measures of demographic characteristics, the University of California, Los Angeles Lifetime Adversities Screener (LADS), depressive symptoms, PTSS, and somatic symptoms. RESULTS An ordinary least-squares regression analysis controlling for age, gender, and race/ethnicity indicated that higher levels of lifetime adversity and trauma were significantly associated with more severe somatic symptoms (b = 6.95, p < .0001). Formal mediation tests indicated that there was a significant indirect effect of LADS on somatic symptoms via PTSS and depressive symptoms, indirect effect = 2.64 (95% confidence interval [CI] [1.2, 4.1]) and 2.19 (95% CI [1.3, 3.3]), respectively. Even after PTSS and depressive symptoms were taken into account, the LADS remained significantly associated with somatic symptoms (b = 2.13, p < .05), suggesting partial mediation. CONCLUSION Exposure to traumatic and adverse events (the LADS) was associated with somatic symptom severity. Furthermore, although PTSS and depressive symptoms partially accounted for the association between the LADS and somatic symptoms, the LADS remained significant, suggesting that both exposure to trauma and adversity and the resultant development of PTSS and depressive symptoms influence the development of somatic symptoms. (PsycINFO Database Record
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Affiliation(s)
- Tamra Burns Loeb
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | | | - Gail E Wyatt
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Muyu Zhang
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Dorothy Chin
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - April Thames
- Department of Psychiatry, University of California, Los Angeles
| | - Yvorn Aswad
- Charles R. Drew University of Medicine and Science, David Geffen School of Medicine at University of California, Los Angeles
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Vidal C, Polo R, Alvarez K, Falgas-Bague I, Wang Y, Lê Cook B, Alegría M. Co-Occurrence of Posttraumatic Stress Disorder and Cardiovascular Disease Among Ethnic/Racial Groups in the United States. Psychosom Med 2018; 80:680-688. [PMID: 29781946 PMCID: PMC6113076 DOI: 10.1097/psy.0000000000000601] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 01/03/2023]
Abstract
OBJECTIVE Trauma and/or symptoms of posttraumatic stress disorder (PTSD) have been linked to the onset of cardiovascular disease (CVD), but the exact mechanism has not been determined. We examine whether the risk of CVD is different among those who have a history of trauma without PTSD symptoms, those who have experienced trauma and developed any symptoms of PTSD, and those with a PTSD diagnosis. Furthermore, we examine whether this association varies across ethnic/racial groups. METHODS We used two data sets that form part of the Collaborative Psychiatric Epidemiology Surveys - the National Latino and Asian American Study and the National Comorbidity Survey Replication. RESULTS We found an increased likelihood of cardiovascular events for those with a diagnosis of PTSD (odds ratio [OR] = 2.10, 95% CI = 1.32-3.33) when compared with those who had not experienced trauma. We did not find an increased risk for those who had experienced trauma without symptoms or with subclinical symptoms of PTSD. The higher likelihood of having a cardiovascular event in those with PTSD was significant for non-Latino whites (OR = 1.86, 95% CI = 1.08-3.11), Latinos (OR = 1.94, 95% CI = 1.04-3.62), and non-Latino blacks (OR = 3.73, 95% CI = 1.76-7.91), but not for Asian respondents. CONCLUSIONS The constellation of symptoms defining PTSD diagnosis reflect adverse reactions to traumatic events and indicate that complex responses to traumatic events may be a risk factor for CVD.
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Affiliation(s)
- Carmen Vidal
- From the Fundación Jiménez Díaz, Avda, Reyes Católicos, Madrid, Spain (Vidal, Polo); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Alvarez, Falgas-Bague, Wang, Alegría); Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Lê Cook); and Department of Psychiatry, Harvard Medical School (Lê Cook), Departments of Medicine and Psychiatry, Harvard Medical School, Boston, Massachusetts (Alegría)
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Chheang D, Connolly EJ. A Review of the Historical, Criminological, and Theoretical Understandings of the Cambodian American Population: A Call for More Comprehensive Research. Int J Offender Ther Comp Criminol 2018; 62:2624-2649. [PMID: 28929837 DOI: 10.1177/0306624x17732579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The collective view of Asian Americans as model minorities is evident with the extensive amount of statistical data showing support for the academic and socioeconomic success of Asian Americans in the United States. This perception, however, often presents an inaccurate portrayal of Asian Americans, in general, as it overlooks many of the difficulties and hardships experienced by Asian American ethnic groups such as Southeast Asians. Within this group, Cambodian Americans are at the highest risk for experiencing socioeconomic hardships, behavioral health problems, substance use disorders, and contact with the criminal justice system, with deportation also being a prevailing issue. Unfortunately, research in this area is scant and contemporary research on Cambodian Americans has several limitations. To begin to address this issue, the present article merges information from existing research on this population from a sociohistorical, criminological, and theoretical standpoint to call for more comprehensive research on Cambodian Americans.
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Affrunti NW, Suárez L, Simpson D. Community violence and posttraumatic stress disorder symptoms in urban youth: The moderating influence of friend and parent support. J Community Psychol 2018; 46:636-650. [PMID: 31682288 DOI: 10.1002/jcop.21963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 06/10/2023]
Abstract
Separate lines of research have demonstrated that community violence predicts posttraumatic stress disorder (PTSD) symptoms in youth and that social support is one protective factor against the development of PTSD symptoms. The current study sought to examine the associations between primary and secondary exposure to community violence and the moderating role of parent and friend support on these relations. Participants were 96 urban youths (aged 6-17 years; 58.4% racial/ethnic minority; 51% female) and a caregiver recruited from a university mental health clinic. Results indicated that both primary and secondary exposure to community violence predicted PTSD symptoms. Friend support, but not parent support, moderated the association between primary, but not secondary, exposure to community violence and PTSD symptoms. The findings suggest that friend support is a salient protective factor for urban youth who may be at risk of PTSD symptoms due to exposure to community violence.
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Herbert MS, Leung DW, Pittman JOE, Floto E, Afari N. Race/ethnicity, psychological resilience, and social support among OEF/OIF combat veterans. Psychiatry Res 2018; 265:265-270. [PMID: 29763847 DOI: 10.1016/j.psychres.2018.04.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 10/03/2017] [Revised: 03/12/2018] [Accepted: 04/28/2018] [Indexed: 11/19/2022]
Abstract
This study examined the relationship between race/ethnicity and psychological resilience, and the moderating role of social support in this relationship among non-Hispanic White (n = 605), Hispanic (n = 107), African American (n = 141), and Asian American (n = 97) Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) combat veterans. Veterans were primarily male (88%) with a mean age of 31.4 years (SD = 8.35). An analysis of covariance showed that Asian American veterans reported significantly lower psychological resilience than non-Hispanic White veterans. The interaction of race/ethnicity and social support with psychological resilience was examined via linear regression. We found that the relationship between psychological resilience and social support significantly differed by race/ethnicity such that social support was positively associated with psychological resilience among non-Hispanic White veterans, but not among other racial/ethnic groups. Our findings are consistent with previous studies that show Asian American veterans report lower psychological resilience than non-Hispanic White veterans. Cultural differences in how and why individuals use social support may underlie racial/ethnic differences in the relationship between social support and psychological resilience. Future qualitative and quantitative research is encouraged to better understand how social support relates to psychological resilience among minority OEF/OIF combat veterans.
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Affiliation(s)
- Matthew S Herbert
- Center of Excellence for Stress and Mental Health (CESAMH) San Diego, CA USA; VA San Diego Healthcare System, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA USA
| | - Desmond W Leung
- Baruch College & The Graduate Center, City University of New York, NY USA
| | - James O E Pittman
- Center of Excellence for Stress and Mental Health (CESAMH) San Diego, CA USA; VA San Diego Healthcare System, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA USA
| | - Elizabeth Floto
- Center of Excellence for Stress and Mental Health (CESAMH) San Diego, CA USA; VA San Diego Healthcare System, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA USA
| | - Niloofar Afari
- Center of Excellence for Stress and Mental Health (CESAMH) San Diego, CA USA; VA San Diego Healthcare System, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA USA.
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Resko SM, Kruman Mountain S, Browne S, Kondrat DC, Kral M. Suicidal Ideation and Suicide Attempts among Women Seeking Treatment for Substance Use and Trauma Symptoms. Health Soc Work 2018; 43:76-83. [PMID: 29474547 DOI: 10.1093/hsw/hly004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/27/2017] [Indexed: 06/08/2023]
Abstract
Substance use disorders and posttraumatic stress disorder have been associated with suicide. Through secondary analysis of the screening data from the Women and Trauma Study conducted by the National Institute on Drug Abuse Clinical Trials Network, the present study examined rates and correlates of suicidal ideation and suicide attempts among women who sought treatment for substance use and trauma at seven outpatient substance use programs. The sample included women between the ages of 18 and 65 years (M = 39.2; SD = 9.3) and was 44 percent white, 33 percent African American, 8 percent Latina, and 15 percent other races or ethnicities. Logistic regression was used to examine factors associated with a lifetime history of recurrent suicidal ideation and a serious suicide attempt. Findings highlight the need for social workers to address elevated risk levels for suicidal thoughts and behaviors when working with women with histories of substance use and trauma.
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Affiliation(s)
- Stella M Resko
- Stella M. Resko, PhD, is associate professor, School of Social Work and Merrill Palmer Skillman Institute; Sarah Kruman Mountain, MSW, is a doctoral candidate, and Suzanne Browne, PhD, is assistant professor, School of Social Work, Wayne State University, Detroit. David C. Kondrat, PhD, is associate professor, School of Social work, Indiana University-Purdue University Indianapolis. Michael Kral, PhD, is associate professor, School of Social Work, Wayne State University, Detroit
| | - Sarah Kruman Mountain
- Stella M. Resko, PhD, is associate professor, School of Social Work and Merrill Palmer Skillman Institute; Sarah Kruman Mountain, MSW, is a doctoral candidate, and Suzanne Browne, PhD, is assistant professor, School of Social Work, Wayne State University, Detroit. David C. Kondrat, PhD, is associate professor, School of Social work, Indiana University-Purdue University Indianapolis. Michael Kral, PhD, is associate professor, School of Social Work, Wayne State University, Detroit
| | - Suzanne Browne
- Stella M. Resko, PhD, is associate professor, School of Social Work and Merrill Palmer Skillman Institute; Sarah Kruman Mountain, MSW, is a doctoral candidate, and Suzanne Browne, PhD, is assistant professor, School of Social Work, Wayne State University, Detroit. David C. Kondrat, PhD, is associate professor, School of Social work, Indiana University-Purdue University Indianapolis. Michael Kral, PhD, is associate professor, School of Social Work, Wayne State University, Detroit
| | - David C Kondrat
- Stella M. Resko, PhD, is associate professor, School of Social Work and Merrill Palmer Skillman Institute; Sarah Kruman Mountain, MSW, is a doctoral candidate, and Suzanne Browne, PhD, is assistant professor, School of Social Work, Wayne State University, Detroit. David C. Kondrat, PhD, is associate professor, School of Social work, Indiana University-Purdue University Indianapolis. Michael Kral, PhD, is associate professor, School of Social Work, Wayne State University, Detroit
| | - Michael Kral
- Stella M. Resko, PhD, is associate professor, School of Social Work and Merrill Palmer Skillman Institute; Sarah Kruman Mountain, MSW, is a doctoral candidate, and Suzanne Browne, PhD, is assistant professor, School of Social Work, Wayne State University, Detroit. David C. Kondrat, PhD, is associate professor, School of Social work, Indiana University-Purdue University Indianapolis. Michael Kral, PhD, is associate professor, School of Social Work, Wayne State University, Detroit
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Shorer S, Goldblatt H, Caspi Y, Azaiza F. Culture as a Double-Edged Sword: The Posttraumatic Experience of Indigenous Ethnic Minority Veterans. Qual Health Res 2018; 28:766-777. [PMID: 29424278 DOI: 10.1177/1049732318756041] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The applicability of Western concepts regarding the treatment of trauma in soldiers from indigenous ethnic minority backgrounds has scarcely been researched. This study explored the subjective meaning of living with chronic posttraumatic stress disorder (PTSD) among indigenous Bedouin veterans of the Israel Defense Forces (IDF), who are of Arab ethnicity and Muslim faith. In-depth, semistructured qualitative interviews were conducted with 10 Bedouin veterans suffering from PTSD and three Bedouin mental health clinicians working with this population. Two themes emerged: "I wanted to be like everyone else," referring to participants' experiences during their military service, and "Fluctuating between belonging and abandonment," referring to veterans' experiences of living with mental health problems in a traditional minority community. These findings highlight the importance of conducting a comprehensive inquiry into the complex cultural and social backgrounds of indigenous minority veterans suffering from PTSD, and the interplay between the conflicted identities and multiple "realities" they experience.
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Affiliation(s)
- Shai Shorer
- 1 HaEmek Medical Center, Afula, Israel
- 2 Bar-Ilan University, Ramat Gan, Israel
| | | | - Yael Caspi
- 4 Rambam Health Care Campus, Haifa, Israel
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Watt MH, Dennis AC, Choi KW, Ciya N, Joska JA, Robertson C, Sikkema KJ. Impact of Sexual Trauma on HIV Care Engagement: Perspectives of Female Patients with Trauma Histories in Cape Town, South Africa. AIDS Behav 2017; 21:3209-3218. [PMID: 27866288 PMCID: PMC5438301 DOI: 10.1007/s10461-016-1617-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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] [Indexed: 10/20/2022]
Abstract
South African women have disproportionately high rates of both sexual trauma and HIV. To understand how sexual trauma impacts HIV care engagement, we conducted in-depth qualitative interviews with 15 HIV-infected women with sexual trauma histories, recruited from a public clinic in Cape Town. Interviews explored trauma narratives, coping behaviors and care engagement, and transcripts were analyzed using a constant comparison method. Participants reported multiple and complex traumas across their lifetimes. Sexual trauma hindered HIV care engagement, especially immediately following HIV diagnosis, and there were indications that sexual trauma may interfere with future care engagement, via traumatic stress symptoms including avoidance. Disclosure of sexual trauma was limited; no women had disclosed to an HIV provider. Routine screening for sexual trauma in HIV care settings may help to identify individuals at risk of poor care engagement. Efficacious treatments are needed to address the psychological and behavioral sequelae of trauma.
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Affiliation(s)
- Melissa H Watt
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA.
| | - Alexis C Dennis
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA
| | - Karmel W Choi
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Nonceba Ciya
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Corne Robertson
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kathleen J Sikkema
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Garcini LM, Peña JM, Gutierrez AP, Fagundes CP, Lemus H, Lindsay S, Klonoff EA. "One Scar Too Many:" The Associations Between Traumatic Events and Psychological Distress Among Undocumented Mexican Immigrants. J Trauma Stress 2017; 30:453-462. [PMID: 29077997 DOI: 10.1002/jts.22216] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/20/2017] [Accepted: 05/22/2017] [Indexed: 11/09/2022]
Abstract
Undocumented immigration often presents with multiple stressors and contextual challenges, which may diminish mental health. This study is the first to provide population-based estimates for the prevalence of traumatic events and its association to clinically significant psychological distress among undocumented Mexican immigrants in the United States. This cross-sectional study used respondent-driven sampling to obtain and analyze data from clinical interviews with 248 undocumented Mexican immigrants residing in high-risk neighborhoods near the California-Mexico border. Overall, 82.7% of participants reported a history of traumatic events, with 47.0% of these meeting the criteria for clinically significant psychological distress. After controlling for relevant covariates, having experienced material deprivation, odds ratio (OR) = 2.26, 95% CI [1.18, 4.31], p = .013, and bodily injury, OR = 2.96, 95% CI [1.50, 5.83], p = .002, and not having a history of deportation, OR = 0.36, 95% CI [0.17, 0.79], p = .011, were associated with clinically significant psychological distress. These results support the need to revisit health and immigration policies and to devise solutions grounded in empirical evidence aimed at preventing the negative effects of trauma and psychological distress in this population.
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Affiliation(s)
- Luz M Garcini
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Juan M Peña
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Angela P Gutierrez
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | | | - Hector Lemus
- Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Suzanne Lindsay
- Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Elizabeth A Klonoff
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
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Gómez JM. Does ethno-cultural betrayal in trauma affect Asian American/Pacific Islander college students' mental health outcomes? An exploratory study. Journal of American College Health 2017; 65:432-436. [PMID: 28617143 DOI: 10.1080/07448481.2017.1341896] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 02/19/2017] [Accepted: 05/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Interpersonal trauma has deleterious effects on mental health, with college students experiencing relatively high rates of lifetime trauma. Asian American/Pacific Islanders (AAPIs) have the lowest rate of mental healthcare utilization. According to cultural betrayal trauma theory, societal inequality may impact within-group violence in minority populations, thus having implications for mental health. In the current exploratory study, between-group (interracial) and within-group (ethno-cultural betrayal) trauma and mental health outcomes were examined in AAPI college students. PARTICIPANTS Participants (N = 108) were AAPI college students from a predominantly white university. Data collection concluded in December 2015. METHODS Participants completed online self-report measures. RESULTS A multivariate analysis of variance revealed that when controlling for interracial trauma, ethno-cultural betrayal trauma significantly impacted dissociation, hallucinations, posttraumatic stress symptoms, and hypervigilance. CONCLUSIONS The results have implications for incorporating identity, discrimination, and ethno-cultural betrayal trauma victimization into assessments and case conceptualizations in therapy.
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Affiliation(s)
- Jennifer M Gómez
- a Department of Psychology , University of Oregon , Eugene , Oregon , USA
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47
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Hoffman Y, Shrira A, Bodner E, Ben-Ezra M. Prime and prejudice: The effect of priming context and prejudicial attitudes on post-traumatic stress disorder symptoms following immigrant violence. Psychiatry Res 2017; 254:224-231. [PMID: 28477544 DOI: 10.1016/j.psychres.2017.04.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 09/02/2016] [Revised: 02/16/2017] [Accepted: 04/26/2017] [Indexed: 11/18/2022]
Abstract
The recent arrival of immigrants into many western countries has become common. Clashes between immigrants and local residents may produce acts of violence. In two studies we assessed post-traumatic stress disorder (PTSD) symptoms in local residents exposed to immigrant violence, while addressing possible effects of priming context and prejudicial attitudes. In Study 1, context was either reminiscent/non-reminiscent of experiencing African immigrant violence (researcher with same/different ethnic origin to that of perpetrators). In Study 2, context was manipulated as a negative ("illegal-migrant") or neutral ("working-immigrant") framing for African immigrants. We also examined if effects of context on trauma symptoms are moderated by prejudicial attitudes towards African immigrants. As expected, higher PTSD symptom levels were evident in the presence of traumatic (Study 1) and negative (Study 2) context, yet only in residents with high prejudicial attitudes. Results suggest that both contexts and prejudice play a role in assessment of PTSD stemming from cultural conflicts. Theoretical implications of the data in terms of PTSD memory theories, are discussed including the notion of a PTSD context theory. Practical implications pertaining to the potential compatibility of researchers and therapists with trauma victims are also addressed.
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Affiliation(s)
- Yaakov Hoffman
- Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel.
| | - Amit Shrira
- Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel
| | - Ehud Bodner
- Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel; Department of Music, Bar-Ilan University, Ramat Gan 5290002, Israel
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48
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Miller A, Hess JM, Bybee D, Goodkind JR. Understanding the mental health consequences of family separation for refugees: Implications for policy and practice. Am J Orthopsychiatry 2017; 88:26-37. [PMID: 28617002 DOI: 10.1037/ort0000272] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Consistent evidence documents the negative impacts of family separation on refugee mental health and concerns for the welfare of distant family members and desire to reunite with family members as priorities for refugees postmigration. Less is known about refugees' emic perspectives on their experiences of family separation. Using mixed methods data from a community-based mental health intervention study, we found that family separation was a major source of distress for refugees and that it was experienced in a range of ways: as fear for family still in harm's way, as a feeling of helplessness, as cultural disruption, as the greatest source of distress since resettlement, and contributing to mixed emotions around resettlement. In addition to these qualitative findings, we used quantitative data to test the relative contribution of family separation to refugees' depression/anxiety symptoms, posttraumatic stress disorder (PTSD) symptoms, and psychological quality of life. Separation from a family member was significantly related to all 3 measures of mental health, and it explained significant additional variance in all 3 measures even after accounting for participants' overall level of trauma exposure. Relative to 26 other types of trauma exposure, family separation was 1 of only 2 traumatic experiences that explained additional variance in all 3 measures of mental health. Given the current global refugee crisis and the need for policies to address this large and growing issue, this research highlights the importance of considering the ways in which family separation impacts refugee mental health and policies and practices that could help ameliorate this ongoing stressor. (PsycINFO Database Record
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Abstract
We administered the Structured Clinical Interview for the DSM to 485 persons seeking HIV testing at five community testing centres in South Africa to determine the prevalence of common mental disorders among this population. The prevalence estimates for the various disorders were as follows: major depressive disorder: 14.2 % (95 % CI [11.1, 17.3]); generalised anxiety disorder 5.0 % (95 % CI [3.07, 6.93]); posttraumatic stress disorder 4.9 % (95 % CI [2.98, 6.82]); and alcohol use disorder 19.8 % (95 % CI [16.26, 23.34]). Our findings imply the need to research the integration of screening and referral trajectories in the context of voluntary HIV counselling and testing.
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Affiliation(s)
- Ashraf Kagee
- Stellenbosch University, Stellenbosch, South Africa.
| | - Wylene Saal
- Stellenbosch University, Stellenbosch, South Africa
| | | | - Mpho Sefatsa
- Stellenbosch University, Stellenbosch, South Africa
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50
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Soykoek S, Mall V, Nehring I, Henningsen P, Aberl S. Post-traumatic stress disorder in Syrian children of a German refugee camp. Lancet 2017; 389:903-904. [PMID: 28271834 DOI: 10.1016/s0140-6736(17)30595-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/25/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Seval Soykoek
- Department of Pediatrics, Child and Adolescent Psychosomatics, Technische Universität München, Munich 81377, Germany
| | - Volker Mall
- Department of Pediatrics, Child and Adolescent Psychosomatics, Technische Universität München, Munich 81377, Germany
| | - Ina Nehring
- Department of Pediatrics, Child and Adolescent Psychosomatics, Technische Universität München, Munich 81377, Germany; Institute of Social Pediatrics and Adolescent Medicine, LMU Munich, Munich, Germany.
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Child and Adolescent Psychosomatics, Technische Universität München, Munich 81377, Germany
| | - Sigrid Aberl
- Department of Psychosomatic Medicine and Psychotherapy, Child and Adolescent Psychosomatics, Technische Universität München, Munich 81377, Germany
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