Shakeh Momartin

Comorbidity of PTSD and depression: associations with trauma exposure, symptom severity and functional impairment in Bosnian refugees resettled in Australia

BACKGROUND Posttraumatic stress disorder (PTSD) is common in refugees but its association with longer-term psychosocial dysfunction remains unclear. We examined whether a subgroup of refugees with comorbid PTSD and depression were at particularly high risk of disability. We also investigated whether specific trauma experiences were linked to this comorbid pattern. METHODS Consecutive Bosnians (and one or two compatriots nominated by them) were recruited from a community centre, yielding a total sample of 126 participants (response rate 86%). Measures included a trauma inventory, the Clinician Administered PTSD Scale (CAPS) (Blake et al., 1995) and the depression module of the Structured Clinical Interview (SCID) (First et al., 1997). RESULTS Three diagnostic groupings emerged: normals (n=39), pure PTSD (n=29), and comorbid PTSD and depression (n=58). Of four trauma dimensions derived from principle components analysis (human rights violations, dispossession and eviction, life threat and traumatic loss), life threat alone was associated with pure PTSD, with life threat and traumatic loss both being associated with comorbidity. Compared to normals and those with pure PTSD, the comorbid group manifested more severe PTSD symptoms as well as higher levels of disability on all indices (global dysfunction: odds ratio=5.0, P<0.001, distress: odds ratio=6.0, P<0.001, social impairment: odds ratio 5.9, P<0.001, and occupational disability: odds ratio 5.0, P<0.001). LIMITATIONS Recruitment was not random, the sample size was modest, and trauma event endorsement was based on retrospective accounts. CONCLUSIONS The combination of life threat and traumatic loss may be particularly undermining to the psychological well-being of refugees and consequent comorbidity of PTSD and depression may be associated with longer-term psychosocial dysfunction. The findings raise the question whether the comorbid pattern identified should be given more recognition as a core posttraumatic affective disorder.

Psychiatric status of asylum seeker families held for a protracted period in a remote detention centre in Australia

Objective: To document the psychiatric status of a near complete sample of children and their families from one ethnic group held for an extended period of time in a remote immigration detention facility in Australia.

Dimensions of trauma associated with posttraumatic stress disorder (PTSD) caseness, severity and functional impairment: a study of Bosnian refugees resettled in Australia

Refugee survivors of inter-ethnic warfare vary greatly in the extent and range of their trauma experiences. Discerning which experiences are most salient to generating and perpetuating disorders such as posttraumatic stress disorder (PTSD) is critical to the mounting rational strategies for targeted psychosocial interventions. In a sample of Bosnian Muslim refugees (n=126) drawn from a community centre and supplemented by a snowball sampling method, PTSD status and associated disability were measured using the clinician-administered PTSD Scale (CAPS) for DSM-IV. A principal components analysis (PCA) based on a pool of trauma items yielded four coherent trauma dimensions: Human Rights Violations, Threat to Life, Traumatic Loss and Dispossession and Eviction. A cluster analysis identified three subgroupings according to extent of trauma exposure. There were no differences in PTSD risk for the group most exposed to human rights violations (internment in concentration camps, torture) compared to the general war-exposed group. Logistic regression analysis using the dimensions derived from the PCA indicated that Threat to Life alone of the four trauma factors predicted PTSD status, a finding that supports the DSM-IV definition of a trauma. Both Threat to Life and Traumatic Loss contributed to symptom severity and disability associated with PTSD. It may be that human rights violations pose a more general threat to the survivors future psychosocial adaptation in areas of functioning that extend beyond the confines of PTSD.

Adult separation anxiety disorder among war-affected Bosnian refugees: Comorbidity with PTSD and associations with dimensions of trauma

Although separation anxiety disorder appears to be common among children exposed to disasters, there are no data focusing on the impact of trauma on adult separation anxiety disorder. The present exploratory study examined the relationship of adult separation anxiety disorder with other psychological reactions (posttraumatic stress disorder [PTSD], complicated grief, depression) and dimensions of trauma among 126 war-affected Bosnian refugees resettled in Australia. Adult separation anxiety disorder was associated with PTSD, but not with complicated grief or depression. Although adult separation anxiety disorder was weakly linked with traumatic losses, this association was nonspecific. Further research is needed to clarify the pathogenic pathways leading to the comorbid PTSD-adult separation anxiety disorder pattern and its clinical implications.

Parent-child concordance for separation anxiety: a clinical study.

There is tentative evidence supporting a familial basis for separation anxiety. The present study aimed to examine parent-child concordance for that subtype of anxiety. Fifty-four children diagnosed with anxiety disorders and their parents (54 mothers and 29 fathers) were recruited from two juvenile anxiety clinics. Sixty-three percent of children diagnosed with juvenile separation anxiety disorder had at least one parent who suffered from the putative adult variant of the disorder (odds ratio = 11.1) (P < 0.001). Affected parents reported high levels of separation anxiety in their own childhoods. Juvenile separation anxiety disorder in children was not associated with any other parental diagnosis. The small sample size and other potential biases caution against definitive conclusions being drawn, but the present data add to existing evidence that separation anxiety may aggregate in families.

Range and Dimensions of Trauma Experienced by Bosnian Refugees Resettled in Australia

Various approaches have been used to conceptualise and represent the range of traumas suffered by survivors of recent genocidal conflicts. This preliminary report describes the dimensions of trauma experienced by Bosnian refugees now residing in Australia, using three illustrative case studies, principal components analysis of traumatic events, and a cluster analysis to examine whether the subjects form groups on the basis of type and intensity of exposure to trauma. One hundred and twenty-six Bosnian refugees, living in Sydney, were recruited through community social groups and a “snowball” procedure. All participants underwent detailed, open-ended interviews concerning their trauma histories and their responses to these experiences. Detailed case histories provided examples of exposure to multiple traumas of a diverse nature,.and examples of complex psychological reactions of anger, humiliation, and helplessness. Principal components analysis of trauma events produced four dimensions: human rights violations and extreme traumatic experiences, dispossession and eviction, threats to life, and loss of family. Survivors reported more exposure to human rights violations and threat to life than to other trauma experiences. Finally, cluster analysis was used to identify different groups of Bosnian refugees on the basis of the type and intensity of their traumatic experiences. Bosnian refugees have been xposed to extreme trauma associated with ethnic cleansing, but subgroups differ according to levels of exposure. Multivariate analysis can produce coherent dimensions of trauma in such groups, but tends not to capture the full range of subjective experiences and reactions to thesecomplex events.

Mental health literacy among refugee communities: differences between the Australian lay public and the Iraqi and Sudanese refugee communities

PurposeThis study investigated differences in mental health knowledge and beliefs between participants from the Iraqi and Sudanese refugee communities, and Australian-born individuals, in Sydney, Australia.MethodsNinety-seven participants were given vignettes of characters describing symptoms of major depressive disorder and posttraumatic stress. They were required to identify psychological symptoms as disorders, rate beliefs about the causes of and helpful treatments for these disorders, and rate attitude statements regarding the two characters.ResultsAustralian participants recognized the presented symptoms as specific mental disorders significantly more than Iraqi and Sudanese participants did, and reported causal and treatment beliefs which were more congruent with expert beliefs as per the western medical model of mental disorder. The Sudanese group endorsed supernatural and religious causal beliefs regarding depression and posttraumatic stress symptoms most often; but both Sudanese and Iraqi participants strongly supported options from the supernatural and religious treatment items. However, evidence for pluralistic belief systems was also found.ConclusionsAlthough sampling was non-random, suggesting caution in the interpretation of results, it appears that the mental health literacy of lay Australians may be more aligned with the western medical model of mental disorder than that of Iraqi and Sudanese refugee communities. Mental health literacy support needs of Iraqi and Sudanese refugee communities resettled in western countries such as Australia might include education about specific symptoms and causes of mental disorder and the effectiveness of psychiatric treatments. These findings provide useful directions for the promotion of optimal service utilization among such communities.