The stigma of widowhood in war and disaster affected communities of Sri Lanka: Contextual paths between trauma exposure and mental health distress.

To add to the dialogue regarding the long-term recovery and wellbeing of war and tsunami-affected women in Sri Lanka, we utilised the Conservation of Resources Theory (COR, Hobfoll, 2009) to inform an investigation of direct and indirect effects. The study was specifically designed to assess how traumatic exposure may represent a form of loss which may associate with related losses in the form of external and internal stigma which may then associate with poor mental health outcomes. The data for this study were collected in 2016 from a sample of 379 widowed women in Eastern Sri Lanka; participant spouses died in the civil war, in the tsunami, or from health or other problems. Our analyses yielded a model suggesting associations between remembered trauma event exposure from war and disaster, external stigma, internalised stigma and mental health symptom distress. Results further yielded direct and indirect effects suggesting that trauma may represent a form of loss, and potentially lead to distress through the weight and challenges of stigma.

War and disaster in Sri Lanka: Implications for widows' family adjustment and perception of self-efficacy in caring for one's family.

The data for this study were collected in 2014 from widows in Eastern Sri Lanka whose spouses died in the civil war, tsunami, or from health-related problems. Conservation of resources (COR) theory was used as a lens to examine the extent to which war and tsunami-related damages and family problems predict variation in social support, family adjustment and a perception of self-efficacy in caring for one's family as reported by widowed women. We also investigated whether social support from the community and social support from family and friends mediated those relationships. Results of a path model fit to the data suggested variation in family adjustment to be negatively predicted by war-related family problems and positively predicted by the social support of friends and family. Additionally, a sense of self-efficacy in caring for one's family was found to be inversely predicted by war-related family problems and tsunami damages. Clinical, social and theoretical implications are discussed as well as directions for further research.

The EIS Model: A Pilot Investigation of a Multidisciplinary Sex Therapy Treatment.

Marital couples not experiencing a satisfying sexual relationship are less satisfied in their overall relationship. There is, however, a paucity of controlled outcome studies researching the effectiveness of sex therapy interventions. This study was a pilot investigation of a new manual-based sex therapy called the EIS (empathy, intimacy, and sexual satisfaction) model. Results showed significant improvement in sexual and marital satisfaction, marital intimacy, and verbal sexual intimacy for men and women, and sexual function for women. Effect sizes were large for these variables and posttreatment differences. Results provide initial support for the theory and interventions of the EIS model. Treatment should include addressing vulnerable communication, relational intimacy, conflict resolution, sexual functioning, sexual medicine care, and sensual and sexual skills.

Predictors of quality of life in 102 patients with treated Cushing's disease.

OBJECTIVE: To identify predictors for quality of life (QoL) in treated Cushing's disease (CD) and quantify patients' assessment of their disease status. CONTEXT: Significant reductions in QoL exist in CD patients despite treatment. Identifying predictors of QoL is paramount to the long-term management of these patents. DESIGN: A cross-sectional study was conducted of patients with treated CD. Patients completed a medical history questionnaire and three validated quality of life assessments: Cushing's QoL Questionnaire (CushingQoL), Hospital Anxiety and Depression Scale (HADS) and Nottingham Health Profile (NHP). PATIENTS: 102 patients (75·7% female, mean time since surgery 7·4 years) with treated CD were included. MEASUREMENTS: Patients were categorized by biochemical and self-identified disease status. Mean CushingQoL, anxiety and depression scores were compared by unpaired t-tests. Multiple linear regressions were performed on the whole cohort to assess for predictors of impaired QoL. RESULTS: Ninety-two per cent of the cohort met criteria for biochemical remission, but only 80·4% felt they had achieved remission. Among those with biochemical remission, those who also self-identified as being in remission had higher CushingQoL scores than those who self-identified as having persistent disease (P = 0·042). Anxiety (P = 0·032) and depression (P = 0·018) scores were lower, and CushingQoL scores were higher (P = 0·05) in patients who self-identified as being in remission compared to persistence. Recovery time, BMI, gender and age were also predictors for QoL. CONCLUSION: Our study identifies the discordance that can exist between biochemical and self-assessed disease status and demonstrates its impact on QoL in patients with CD. These findings highlight the importance of incorporating patients' disease perceptions in their management.

Trauma-focused therapy for refugees: meta-analytic findings.

High levels of trauma-related psychological distress have been documented among ethnically diverse refugees. As the number of refugees worldwide continues to grow, determining the efficacy of established methods of trauma-focused therapy for this population is crucial. This meta-analysis examined the results of randomized controlled trials of psychotherapeutic intervention for traumatized adult refugees. Comparisons of 13 trauma-focused therapies to control groups from 12 studies were included in the analysis. The aggregate effect size for the primary outcome, posttraumatic stress disorder (PTSD), was large in magnitude, Hedge's g = .91, p < .001, 95% CI [.56, 1.52]. The aggregate effect size for depression, assessed in 9 studies, was also large g = .63, p < .001, 95% CI [.35, .92]. We used metaregression to evaluate potential moderators of the PTSD effect size. Number of sessions significantly predicted magnitude of the effect size, and studies that utilized an active control group (e.g., supportive counseling) had significantly smaller effect size than those with a passive control group. There was no difference in outcome for studies where an interpreter was used to facilitate sessions and those where no interpreter was used. There also was no difference in outcome based on type of PTSD assessment. Results provide evidence in the efficacy of trauma-focused models for treating refugees, and also shed light on important areas for future research.

Association between parents' PTSD severity and children's psychological distress: a meta-analysis.

The authors conducted a meta-analysis of studies on the correlation between parents' PTSD symptom severity and children's psychological status. An extensive search of the literature yielded 550 studies that were screened for inclusion criteria (i.e., parent assessed for PTSD, child assessed for distress or behavioral problems, associations between parent PTSD and child status examined). Sixty-two studies were further reviewed, resulting in a final sample of 42 studies. Results yielded a moderate overall effect size r = .35. The authors compared effect sizes for studies where only the parent was exposed to a potentially traumatic event to studies where both parents and children were exposed. A series of moderators related to sample characteristics (sex of parent, type of traumatic event) and study methods (self-report vs. diagnostic interview, type of child assessment administered) were also evaluated. The only significant moderator was type of trauma; the effect size was larger for studies with parent-child dyads who were both exposed to interpersonal trauma (r = .46) than for combat veterans and their children (r = .27) and civilian parent-child dyads who were both exposed to war (r = .25). Results support the importance of considering the family context of trauma survivors and highlight areas for future research.

Unpacking gender-specific risk and protective factors for mental health status among Congolese refugees in Uganda.

Background: Research indicates refugees from the Democratic Republic of Congo (DRC), particularly females, have a higher incidence of mental health problems compared to the global norm for conflict-affected populations.Objective: This study aimed to unpack gender differences in the mental health of Congolese refugees by examining specific risk (trauma exposure, adaptation challenges, and discrimination) and protective factors (marital status, literacy, and social resources) in relation to posttraumatic stress symptoms (PTSS) and depression. Method: Utilizing systematic random sampling, we surveyed 667 adult refugees (370 females, 297 males) in the Kyaka II refugee settlement in Western Uganda. A multi-group path analysis was conducted, initially allowing for variance between genders and subsequently comparing a constrained model, where paths were set equal across groups.Results: The unconstrained model presented an excellent fit to the data. When paths were set to be equal across groups, the decline in model fit, confirmed by a chi-square difference test, indicated differences in the model for males and females. A series of Z-tests were used to compare individual paths. Experiencing discrimination was a stronger risk factor for depression among men, whereas a history of rape was more strongly associated with depression for females. Being literate and a member of a social group in the settlement were stronger protective factors for depression among men, whereas living with a partner and a felt sense of connection to their community was more important for women. Associations between risk and protective factors and PTSS were more similar across groups, only membership in a group was significantly moderated by gender; with group membership being more impactful for males.Conclusion: The results highlight similarities and differences in predictors of distress for male and female Congolese refugees and point to potential avenues for tailoring programming to be gender sensitive.

This research identified key differences in how specific traumatic experiences and social factors correlate with psychological distress for male and female Congolese refugees, underscoring the need for tailored support strategies.The study reveals that while discrimination is a stronger predictor of depression in men, experiences of rape are more closely linked to depression in women. Conversely, social factors like literacy and group membership offer more protection to men, whereas relationship status and community connection are more protective for women.The findings shed light on the importance of gender-sensitive mental health and psychosocial support interventions.

A lithium-aluminium heterobimetallic dimetallocene.

Homobimetallic dimetallocenes exhibiting two identical metal atoms sandwiched between two η5 bonded cyclopentadienyl rings is a narrow class of compounds, with representative examples being dizincocene and diberyllocene. Here we report the synthesis and structural characterization of a heterobimetallic dimetallocene, accessible through heterocoupling of lithium and aluminylene fragments with pentaisopropylcyclopentadienyl ligands. The Al-Li bond features a high ionic character and profits from attractive dispersion interactions between the isopropyl groups of the cyclopentadienyl ligands. A key synthetic step is the isolation of a cyclopentadienylaluminylene monomer, which also enables the structural characterization of this species. In addition to their structural authentication by single-crystal X-ray diffraction analysis, both compounds were characterized by multinuclear NMR spectroscopy in solution and in the solid state. Furthermore, reactivity studies of the lithium-aluminium heterobimetallic dimetallocene with an N-heterocyclic carbene and different heteroallenes were performed and show that the Al-Li bond is easily cleaved.

Refugee posttraumatic growth: A grounded theory study.

In response to the unprecedented refugee crisis around the world, a growing body of research has focused on psychological distress among individuals and families forced to flee their homelands. Less attention has been directed toward understanding resilience, adaptation, and growth among this population. This grounded theory study explored the posttraumatic growth experiences of Middle Eastern and Afghan refugees resettled in the United States. The principal researcher conducted 23 interviews with seven couples and 16 individuals aged 25 to 67 years, from Afghanistan, Iraq, Iran, and Syria. This study aimed to explore how refugees understand, process, overcome, and grow from the trauma and adversity they have experienced. Findings were used to delineate a model of the process through which refugees experience posttraumatic growth. The overarching theme of moving forward had five specific growth themes: increased awareness of context; tolerating uncertainty; spiritual/religious attunement; consideration of others; and integrating into society. Findings shed light on the complex process of growth and adaptation in the aftermath of war and forced migration. The model can serve as a tool for clinicians to facilitate more empowering posttraumatic narratives with refugee clients rooted in growth experiences.

Bis(di-tert-butylindenyl)tetrelocenes.

The synthesis and characterization of bis(di-tert-butylindenyl) germanium(II), tin(II) and lead(II) complexes are reported, which includes the first structurally authenticated example of a bis(indenyl)germanocene. The species were studied in detail in solution and in the solid, which includes single crystal X-ray diffraction and NMR spectroscopy, as well as Mössbauer spectroscopy of the tin compound.

Male osteoporosis: epidemiology and the pathogenesis of aging bones.

Osteoporosis in men is an overlooked yet increasingly important clinical problem that, historically, has not received the same degree of awareness as with women. Epidemiologic studies demonstrate that male osteoporosis contributes significantly to the burden of osteoporotic fractures, especially among the aging population. In particular, men have increased morbidity and mortality associated with osteoporotic fractures compared with women. Diagnostic challenges of male osteoporosis include lack of consensus about appropriate reference ranges for identifying osteoporosis in men, and the lack of a fracture assessment tool in men necessary to identify those individuals at risk. Compared with women, changes that occur in the aging male skeleton include trabecular thinning, greater endocortical expansion, ongoing periosteal apposition with greater bending strength, and preserved minimum moment of inertia. Overall, men have less microstructural damage with aging and beneficial geometric adaptations that lead to stronger bones, compared with women, and thus their overall lower risk of fractures.

Posttraumatic stress and depression among women in Kenya's informal settlements: risk and protective factors.

Background: Approximately 56% of Kenya´s population resides in informal settlements (UN-Habitat, 2016). Female residents experience a range of psychosocial stressors including chronic poverty and high rates of interpersonal violence. Despite evidence that this population has some of the worst physical health outcomes in the country (APHRC, 2014), few studies have evaluated their mental health status and its correlates. Objective: The purpose of this study was to identify risk and protective factors associated with mental health problems (posttraumatic stress & depression) among women living in informal settlements in Kenya. Hypothesized risk factors included economic stress, a history of experiencing childhood abuse and sexual violence, as well as partner-perpetrated psychological and physical abuse. Hypothesized protective factors were supportive relationships with family members and friends and having a sense community connection. Method: Local community health workers were trained to collect data via individual interviews using validated measures. Participants were recruited using systematic random sampling in two informal settlements in Nakuru County. We used path analysis to test the hypothesized model among a sample of 301 women. Results: The model had an excellent fit (χ2 = 13.391, df = 8, p =.099; GFI =.99; CFI =.99; RMSEA =.05) and explained 25% of the variance in PTSS and 28% of the variance in depression. All predictor variables except support from friends were statistically significant in the expected direction. Specifically, economic stress, childhood abuse, sexual violence, as well as physical and psychological abuse from one´s partner had significant positive associations with PTSS and depression. Having supportive family members and a sense of being part of the community had significant negative associations with symptoms. Conclusions: Results highlight the importance of addressing intimate partner and other forms of interpersonal violence in these settings and hold implications for tailoring interventions for this marginalized population.

Antecedentes: Aproximadamente, el 56 % de la población de Kenia vive en asentamientos informales (Naciones Unidas, 2015). Las mujeres que viven en estos asentamientos experimentan un amplio espectro de estresores psicosociales, incluyendo a la pobreza crónica y a altos niveles de violencia interpersonal. Pese a que existe evidencia respecto a que esta población tiene los peores indicadores de salud física (Centro de Investigación sobre la Población y Salud Africanas, 2012), son muy pocos los estudios que han evaluado el estado de su salud mental y factores relacionados.Objetivo: El objetivo de este estudio fue el de identificar factores protectores y de riesgo asociados a problemas de salud mental (estrés postraumático y depresión) en mujeres que viven en asentamientos informales en Kenia. Los factores de riesgo hipotéticos fueron el estrés económico, el antecedente de haber experimentado abuso infantil y violencia sexual, así como el haber experimentado abuso psicológico y físico por parte de la pareja. Los factores protectores hipotéticos fueron las relaciones interpersonales de soporte con familiares y amigos y el tener una sensación de conexión con la comunidad.Métodos: Se capacitó a los trabajadores de salud mental comunitaria locales en la recolección de datos a través de entrevistas individuales y el uso de escalas validadas. Se reclutó a las participantes mediante un muestreo por aleatorización sistemática realizado en dos asentamientos informales en el condado de Nakuru. Se realizaron análisis de ruta para evaluar el modelo hipotetizado en una muestra de 301 mujeres.Resultados: El modelo mostró un encaje excelente (χ2 = 13.391, df = 8, p = .099; GFI = .99; CFI = .99; RMSEA = .05) y explicó el 25 % de la varianza en los síntomas de estrés traumático (PTSS) y el 28 % de la varianza en los de depresión. Todas las variables predictivas, a excepción del soporte por parte de los amigos, resultaron ser estadísticamente significativas en la dirección esperada. De manera específica, el estrés económico, el abuso infantil, la violencia sexual y el abuso físico y psicológico por parte de la propia pareja mostraron asociaciones positivas significativas con los PTSS y de la depresión. El tener soporte por parte de los miembros de la familia y el tener un sentido de pertenencia a la comunidad mostraron asociaciones negativas significativas con los síntomas.Conclusiones: Los resultados enfatizan la importancia de abordar la violencia ejercida por la pareja y otras formas de violencia interpersonal en estos escenarios, además de tener implicancias para el diseño de intervenciones específicas para estas poblaciones excluidas.

The effects of resistance training on quality of life in cancer: a systematic literature review and meta-analysis.

PURPOSE: The purpose of this study was to carry out a systematic review and meta-analysis to evaluate the effect of resistance training upon quality of life (QoL) in cancer. SEARCH STRATEGY: A wide range of electronic databases were searched from inception to October 2009 using relevant key words. Reference lists of all studies identified for inclusion and relevant reviews were also searched. Relevant journals were hand searched and experts in the field contacted. SELECTION CRITERIA: Randomized controlled trials that investigated the specific effect of resistance training on QoL in adult cancer survivors were included. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed methodological quality and extracted data based upon predefined criteria. A meta-analysis was performed for QoL using a random effects model. RESULTS: Six studies were identified for inclusion. Two studies demonstrated a significantly beneficial effect of resistance training on QoL compared to usual care. Post-test means ± standard deviations were available for all comparisons providing data for 278 participants who received a resistance training intervention and 270 control participants. The results of the meta-analysis demonstrated that, at the end of the intervention period, resistance training was statistically more effective than the control intervention (SMD -0.17, 95% CIs -0.34 to -0.00). Overall, there was heterogeneity between studies in relation to tumor type, stage of cancer treatment, type of cancer treatment, and duration of the intervention. CONCLUSIONS: Existing evidence suggests that strength training programs for cancer survivors have marginal benefit. Further, fully powered studies are required to determine the optimal type, intensity, and timing of resistance training.

The treatment of mental illness in faith-based and traditional healing centres in Ghana: perspectives of service users and healers.

BACKGROUND: The maltreatment of people with mental illness in Ghana's traditional and faith-based healing centres, including shackling, flogging, and forced fasting, has been documented by numerous sources. Such treatment is potentially traumatising and may exacerbate mental health problems. Despite widespread use, few studies have focused on experiences and characteristics of people who seek traditional healing for mental illness or healers' perspectives treatment of these conditions. METHOD: Purposeful sampling was used to recruit 82 individuals who were treated in healing centres and 40 traditional healers; all took part in semi-structured interviews. Those treated were asked about experiences in centres and assessed for prior trauma exposure, posttraumatic stress, and functional impairment. Healers were asked about beliefs and practices related to the treatment of mental illness. RESULTS: Individuals treated in centres and healers generally believed that mental illness has a spiritual cause. Approximately 30.5% of those treated in centres were exposed to maltreatment; despite this, half would return. Individuals with a history of trauma were more likely to report maltreatment in the centre and had higher symptoms of posttraumatic stress. Most participants had impaired functioning. Healers who used practices like shackling believed they were necessary. Most healers were willing to collaborate with the official health structure. CONCLUSION: Results provide insight into the treatment of mental illness by traditional healers in Ghana and the need for trauma-informed mental health services. Findings also highlight the importance of considering cultural beliefs when attempting to implement mental health interventions in the region.

Subjective reactions to international research participation: An illustration of ethical considerations with women heading households in Sri Lanka.

There are unique ethical considerations in conducting international research with war and disaster-affected populations that are important for ensuring adequate protection of participants. Of particular importance is the distress that participants may experience as a result of being asked about traumatic stressors, psychological symptoms, and life problems. In this study, trauma-affected Tamil women in Eastern Sri Lanka were asked to report on their research-participation experience after taking part in a larger study on risk and resiliency. Results indicated that most participants experienced emotional upset as a result of taking part in the study. However, the degree of distress was generally not more than they anticipated, and most participants reported they would have participated had they known in advance how they would feel. Most participants perceived some benefit as a result of participating and agreed that items were personally relevant. Emotional distress from participation positively correlated with culturally specific symptoms of anxiety and depression. Contextual stressors and social support were not associated with participation-related distress. We discuss these findings as well as general issues that might arise in international research with trauma-affected populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Toward understanding posttraumatic stress and depression among trauma-affected widows in Sri Lanka.

OBJECTIVE: In this study, we applied conservation of resources theory (Hobfoll, 1989) to explain high rates of depression and posttraumatic stress symptoms (PTSS) among war- and disaster-affected Tamil widows in the Eastern Province of Sri Lanka. We hypothesized exposure to potentially traumatic events and severity of current contextual problems would influence PTSS and depressive symptoms directly and indirectly through loss of psychological (view of self), environmental (sense of community), and energy (physical health) resources. METHOD: Trained research assistants interviewed a convenience sample (N = 381) of women, using established measures of the constructs of interest. Data were analyzed using path analysis in MPlus. The significance of the indirect effects was tested using bootstrapping. RESULTS: The model had an acceptable fit (χ2 = 4.06, df = 1, p < .05; Log Likelihood = -3344.26*; AIC = 6760.59; BIC = 6894.64; RMSEA = 0.09; CFI = .99; TLI = .91; SRMR = .02) and explained approximately 38% of the variance in both PTSS and depression. Contextual problems were significantly associated with PTSS and depression both directly and indirectly through deleterious effects on view of self, health status, and sense of community. Degree of trauma exposure was directly associated with indicators of distress. CONCLUSION: Results support the utility of COR theory in this context and hold implications for research and program development. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Relationship of differentiation of self to adult clients' perceptions of the alliance in brief family therapy.

The authors examined differentiation of self, a multidimensional construct in Murray Bowen's (1976, 1978) family systems theory, as a predictor of clients' perceptions of the therapeutic alliance. Adult clients (N=38) in brief family therapy completed the Differentiation of Self Inventory-Revised (Skowron & Schmitt, 2003) during prescreening and the self-report version of the System for Observing Family Therapy Alliances (Friedlander & Escudero, 2002) after Session 3. More differentiated adults reported significantly more positive overall alliances. In a canonical correlation analysis, four roots were extracted that together accounted for 56% of the shared variance. Interpretation of the single significant canonical root suggested that clients reporting less emotional reactivity were more likely to have strong feelings of safety in the family therapy context.

How do therapists enhance family alliances? Sequential analyses of therapist-client behavior in two contrasting cases.

To identify alliance-related behavior patterns in more and less successful family therapy, the authors intensively analyzed two cases with highly discrepant outcomes. Both families were seen by the same experienced clinician. Results showed that participants' perceptions of the alliance, session impact, and improvement at three points in time were congruent with the families' differential outcomes and with observer-related alliance behavior using the System for Observing Family Therapy Alliances. In this measure, therapist behaviors contribute to the alliance and client behaviors reveal the strength of the alliance on four dimensions: Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety within the Therapeutic System, and Shared Sense of Purpose within the Family. In the poor outcome case, observer ratings and self-reported alliance scores revealed a persistently "split" alliance between family members; this family dropped out midtreatment. Only in the good outcome case did the clients follow the therapist's alliance-building interventions with positive alliance behaviors; sequential analyses showed that therapist contributions to Engagement significantly activated client Engagement behavior, and therapist Emotional Connection interventions significantly activated client Emotional Connection. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

PTSD symptoms among tsunami exposed mothers in Sri Lanka: the role of disaster exposure, culturally specific coping strategies, and recovery efforts.

BACKGROUND AND OBJECTIVES: Women in Sri Lanka have been uniquely exposed to a complex and protracted set of stressors stemming from a civil war conflict spanning over 25 years and the tsunami which struck Southeast Asia in 2004. This study investigates coping strategies and their association with trauma-related symptoms of tsunami-exposed mothers in Sri Lanka at two time points. DESIGN: Data for this study come from surveys administered in two waves of data collection to investigate both mothers' and adolescent children's post-tsunami mental health in early 2005, three months after the tsunami struck, and again in 2008, three years later. METHODS: Latent-variable structural equation modeling was used to test the study hypotheses among 160 tsunami-affected mothers in the Polhena village, Matara district, Sri Lanka. RESULTS: Among the various coping strategies examined, the use of cultural rituals as well as inner psychological strength was associated with lower levels of posttraumatic stress symptoms. In contrast, passive religious beliefs were associated with greater posttraumatic stress levels. CONCLUSIONS: The results of this study reveal the differential associations of various coping strategies including rituals used by mothers exposed to the tsunami in Sri Lanka and their posttraumatic stress symptom levels.

Stories of the Accused: A Phenomenological Inquiry of MFTs and Accusations of Unprofessional Conduct.

Interviews were conducted with 10 MFTs (six females and four males) who had received a formal accusation of unprofessional conduct and went before state licensure boards in three different states. Accusations included dual relationships, financial fraud/errors, receiving DUIs, sexual misconduct, and emotionally harming a client. Utilizing Moustakas' (1994, Phenomenological research methods, Thousand Oaks, CA: Sage) transcendental phenomenology, five essential themes emerged: (a) The experience of being formally accused of unprofessional conduct is life-changing, (b) state MFT licensing boards are more punitive than rehabilitative, (c) obtaining support is vital, (d) making accusations creates stigma, (e) therapists were unprepared to handle accusations of unprofessional conduct. Clinical implications include the importance of supervision, personal therapy, and strategies for prevention and rehabilitation with this population.