Climate and fire impacts on tree recruitment in mixed conifer forests in northwestern Mexico and California.

Frequent-fire forests were once heterogeneous at multiple spatial scales, which contributed to their resilience to severe fire. While many studies have characterized historical spatial patterns in frequent-fire forests, fewer studies have investigated their temporal dynamics. We investigated the influences of fire and climate on the timing of conifer recruitment in old-growth Jeffrey pine-mixed conifer forests in the Sierra San Pedro Martir (SSPM) and the eastern slope of the Sierra Nevada. Additionally, we evaluated the impacts of fire exclusion and recent climate change on recruitment levels using statistical models with realized as well as fire suppression and climate change-free counterfactual scenarios. Excessive soil drying from anthropogenic climate change resulted in diminished recruitment in the SSPM but not in the Sierra Nevada. Longer fire-free intervals attributable to fire suppression and exclusion resulted in greater rates of recruitment across all sites but was particularly pronounced in the Sierra Nevada, where suppression began >100 years ago and recruitment was 28 times higher than the historical fire return interval scenario. This demonstrates the profound impact of fire's removal on tree recruitment in Sierra Nevada forests even in the context of recent climate change. Tree recruitment at the SSPM coincided with the early-20th-century North American pluvial, as well as a fire-quiescent period in the late 18th and early 19th centuries. Episodic recruitment occurred in the SSPM with no "average" recruitment over the last three centuries. We found that temporal heterogeneity, in conjunction with spatial heterogeneity, are critical components of frequent-fire-adapted forests. Episodic recruitment could be a desirable characteristic of frequent-fire-adapted forests, and this might be more amenable to climate change impacts that forecast more variable precipitation patterns in the future. One key to this outcome would be for frequent fire to continue to shape these forests versus continued emphasis on fire suppression in California.

Mega-disturbances cause rapid decline of mature conifer forest habitat in California.

Mature forests provide important wildlife habitat and support critical ecosystem functions globally. Within the dry conifer forests of the western United States, past management and fire exclusion have contributed to forest conditions that are susceptible to increasingly severe wildfire and drought. We evaluated declines in conifer forest cover in the southern Sierra Nevada of California during a decade of record disturbance by using spatially comprehensive forest structure estimates, wildfire perimeter data, and the eDaRT forest disturbance tracking algorithm. Primarily due to the combination of wildfires, drought, and drought-associated beetle epidemics, 30% of the region's conifer forest extent transitioned to nonforest vegetation during 2011-2020. In total, 50% of mature forest habitat and 85% of high density mature forests either transitioned to lower density forest or nonforest vegetation types. California spotted owl protected activity centers (PAC) experienced greater canopy cover decline (49% of 2011 cover) than non-PAC areas (42% decline). Areas with high initial canopy cover and without tall trees were most vulnerable to canopy cover declines, likely explaining the disproportionate declines of mature forest habitat and within PACs. Drought and beetle attack caused greater cumulative declines than areas where drought and wildfire mortality overlapped, and both types of natural disturbance far outpaced declines attributable to mechanical activities. Drought mortality that disproportionately affects large conifers is particularly problematic to mature forest specialist species reliant on large trees. However, patches of degraded forests within wildfire perimeters were larger with greater core area than those outside burned areas, and remnant forest habitats were more fragmented within burned perimeters than those affected by drought and beetle mortality alone. The percentage of mature forest that survived and potentially benefited from lower severity wildfire increased over time as the total extent of mature forest declined. These areas provide some opportunity for improved resilience to future disturbances, but strategic management interventions are likely also necessary to mitigate worsening mega-disturbances. Remaining dry mature forest habitat in California may be susceptible to complete loss in the coming decades without a rapid transition from a conservation paradigm that attempts to maintain static conditions to one that manages for sustainable disturbance dynamics.

Testing the effectiveness and acceptability of online supportive supervision for mental health practitioners in humanitarian settings: a study protocol for the caring for carers project.

BACKGROUND: Local humanitarian workers in low and middle-income countries must often contend with potentially morally injurious situations, often with limited resources. This creates barriers to providing sustainable mental health and psychosocial support (MHPSS) to displaced individuals. Clinical supervision is an often neglected part of ensuring high-quality, sustainable care. The Caring for Carers (C4C) project aims to test the effectiveness and acceptability of online group-based supportive supervision on the well-being of MHPSS practitioners, as well as service-user-reported service satisfaction and quality when working with displaced communities in Türkiye, Syria, and Bangladesh. This protocol paper describes the aim, design, and methodology of the C4C project. METHOD: A quasi-experimental, mixed-method, community-based participatory research study will be conducted to test the effectiveness of online group-based supportive clinical supervision provided to 50 Syrian and 50 Bangladeshi MHPSS practitioners working with Syrian and Rohingya displaced communities. Monthly data will be collected from the practitioners and their beneficiaries during the active control (six months) and supervision period (16 months over two terms). Outcomes are psychological distress (Kessler-6), burnout (the Copenhagen Burnout Inventory), compassion fatigue, compassion satisfaction, and secondary traumatic stress (Professional Quality of Life Scale), perceived injustice, clinical self-efficacy (Counseling Activity Self-Efficacy Scale), service satisfaction, and quality (Client Satisfaction Questionnaire and an 18-item measure developed in this project). A realist evaluation framework will be used to elucidate the contextual factors, mechanisms, and outcomes of the supervision intervention. DISCUSSION: There is a scarcity of evidence on the role of clinical supervision in improving the well-being of MHPSS practitioners and the quality of service they provide to displaced people. By combining qualitative and quantitative data collection, the C4C project will address the long-standing question of the effectiveness and acceptability of clinical supervision in humanitarian settings.

Breaching the family walls: Modelling the impact of prolonged visa insecurity on asylum-seeking children.

OBJECTIVE: Children in asylum-seeking families are increasingly subject to deterrent host nation policies that undermine security in the post-migration context, however, little is known on the mental health consequences of such policy. This study examined the impact of prolonged visa insecurity on child mental health, by comparing two cohorts of refugee children entering Australia between 2010 and 2013, distinguished by visa security. METHODS: The insecure visa sample comprised children from Tamil asylum-seeking families, while the secure visa sample was drawn from refugee families participating in the multi-ethnic 'Building a New Life in Australia' cohort study. Children in each sample were assessed for current mental health problems and trauma exposure. Mothers were assessed for trauma exposure, post-migration family stressors and post-traumatic stress disorder (PTSD). The effects of prolonged visa insecurity on child mental health via family-and child-level variables were modelled using multi-level path analysis. RESULTS: Data comprised 361 children, aged 10-18, and 242 mothers across three levels of visa insecurity: permanent protection (n = 293), temporary protection (n = 40) and bridging visa (n = 28). Modelling showed that (1) visa insecurity was associated with poorer child mental health, (2) the association was mediated sequentially by post-migration family stressors and maternal PTSD and (3) the association was moderated by maternal PTSD. CONCLUSION: Our findings suggest that when government policy persistently undermines post-migration security, the capacity of families to protect children from accrued stressors is lowered, leaving a significantly higher proportion of children developing along trajectories of risk rather than resilience.

The impact of immigration detention on the mental health of refugees and asylum seekers.

Studies consistently report that asylum seekers held in immigration detention have relatively high rates of mental distress, yet evidence of the long-term impact of immigration detention is limited. Using propensity score-based methods, we estimated the impact of immigration detention on the prevalence of nonspecific psychological distress, using the Kessler-6, and probable posttraumatic stress disorder (PTSD), using the PTSD-8, among participants in a national sample of asylum seekers in the 5 years following their resettlement in Australia (N = 334). At Wave 1, the prevalence of nonspecific psychological distress was high among all participants regardless of detainment status, OR = 0.28, 95% CI [0.04, 2.06], and did not change over time for either detainees (n = 222), OR = 1.01, 95% CI [0.46, 2.18], or nondetainees (n = 103), OR = 0.81, 95% CI [0.39, 1.67]. In contrast, the odds of probable PTSD were significantly higher for former detainees, OR = 8.20; 95% CI [2.61, 26.73], than nondetainees at Wave 1; although they declined among former detainees, OR = 0.56, 95% CI [0.38, 0.82]), and increased among nondetainees, OR = 1.57, 95% CI [1.11, 2.23], in the years following resettlement. These results imply the use of immigration detention to manage unauthorized migration increases the prevalence of probable PTSD in the short term among former detainees who have resettled in Australia.

Anger and predictors of drop-out from PTSD treatment of veterans and first responders.

BACKGROUND: Drop-out is an important barrier in treating post-traumatic stress disorder (PTSD) with consequences that negatively impact clients, clinicians and mental health services as a whole. Anger is a common experience in people with PTSD and is more prevalent in military veterans. To date, no research has examined if anger may predict drop-out in military veterans or first responders. AIMS: The present study aimed to determine the variables that predict drop-out among individuals receiving residential treatment for PTSD. METHOD: Ninety-five military veterans and first responders completed pre-treatment measures of PTSD symptom severity, depression, anxiety, anger, and demographic variables. Logistic regression analyses were used to determine if these variables predicted drop-out from treatment or patterns of attendance. RESULTS: Female gender was predictive of drop-out. However, when analysed by occupation female gender was predictive of drop-out among first responders and younger age was predictive of drop-out in military participants. Anger, depression, anxiety and PTSD symptom severity were not predictive of drop-out in any of the analyses. No variables were found to predict attendance patterns (consistent or inconsistent) or early versus late drop-out from the programme. CONCLUSION: These results suggest that although anger is a relevant issue for treating PTSD, other factors may be more pertinent to drop-out, particularly in this sample. In contrast with other findings, female gender was predictive of drop-out in this study. This may indicate that in this sample, there are unique characteristics and possible interacting variables that warrant exploration in future research.

Changes in intolerance of uncertainty over the course of treatment predict posttraumatic stress disorder symptoms in an inpatient sample.

Intolerance of uncertainty (IU) is the inability to tolerate distress that arises in response to the absence of important information. The level of IU has been investigated across various psychological disorders; however, few studies have examined IU in trauma-affected samples. We aimed to investigate the relationship between IU and posttraumatic stress disorder (PTSD) across the course of treatment. Participants (n = 106) had a diagnosis of PTSD and were from first responder, military, and occupational injury backgrounds. Participants completed self-report questionnaires pre- and post-engagement in an inpatient group trauma-informed psychoeducation and skills (TIPS) intervention. Regression analyses indicated that decreases in overall and inhibitory IU were associated with decreases in PTSD severity overall and at the symptom cluster level. However, prospective IU was only associated with changes in the re-experiencing, avoidance, and arousal PTSD symptom clusters. Our findings are congruent with the nascent literature indicating that IU may be a maintaining factor for PTSD, suggesting clinical relevance for attendance to IU within the course of treatment.

Repetitive Transcranial Magnetic Stimulation: Influence on Stress and Early Responsiveness Outcomes for Depression, Anxiety, and Stress.

The present study investigated whether rTMS treatment for depression reduced stress and whether early responsiveness of rTMS predicted outcomes for depression, anxiety, and stress at the conclusion of treatment. Participants (n = 109) were inpatients at a psychiatric hospital referred for rTMS for depression. Linear mixed models were used to analyse data across time and regression analyses were used to assess early responsiveness. Effect sizes, and clinically significant and reliable change were also analysed. Decreases in scores for depression, anxiety, and stress were evident from pre- to mid-treatment, and from mid- to post-treatment. Large effect sizes were reported from pre- to post-treatment for depression and stress. Changes in depression from pre- to mid-treatment predicted post-treatment depression and stress scores. Clinically significant change was most common for stress and reliable change was most common for depression. Standard rTMS treatment for depression appears to have non-specific benefits in that participant anxiety and stress ratings also improve significantly. Early improvements in depressive symptoms may be indicative of later depression and stress outcomes, suggesting clinical benefit in assessing outcomes during rTMS treatment.

An open trial of the RECONNECT exercise program for NSW Police Officers with posttraumatic stress disorder or psychological injury.

OBJECTIVE: Posttraumatic stress disorder (PTSD) and psychological injuries are debilitating health problems facing police officers. There is increasing interest in the role of exercise as an intervention. We aimed to determine the preliminary effectiveness of the RECONNECT exercise program for NSW Police Officers experiencing PTSD or psychological injury. METHODS: An open trial was conducted between 2016 and 2017 across three NSW sites. RECONNECT consisted of twice weekly, supervised exercise sessions for three months. Outcomes were assessed at baseline, week 6 and week 12 (intervention completion) and included PTSD symptoms, depression, anxiety and stress, insomnia severity and alcohol use. Data were analysed using linear mixed models. RESULTS: In total, n = 60 Officers were consecutively referred to the program (35% female, mean age 42.0 ± 8.9 years). The majority had a clinical diagnosis of PTSD (n = 48, 80%). A clinically significant reduction in PTSD (Cohen's d = 0.96), depression (d = 0.71), anxiety (d = 0.55) and stress (d = 0.69) symptoms was found from baseline to week 12. Drop-out and lost to follow-up was high. Higher baseline PTSD severity was associated with an increased likelihood to complete postintervention assessment. CONCLUSIONS: RECONNECT appears to be effective in reducing symptoms of PTSD. Exercise may be an effective component of PTSD treatment.

Feasibility of an online, mental health-informed lifestyle program for people aged 60+ years during the COVID-19 pandemic.

ISSUE ADDRESSED: The COVID-19 pandemic and associated social distancing regulations have disproportionally impacted the health of older adults. Lifestyle interventions targeting physical activity, diet and fostering social connection may help to alleviate the potential negative health consequences. This study aimed to determine the feasibility and preliminary effectiveness of delivering an online group lifestyle intervention for older adults during the COVID-19 pandemic. METHODS: Adults aged 60+, living in Australia were recruited to a single-arm feasibility study of a 6-week program delivered via a private Facebook group between June-August 2020. Facilitators provided motivation and education on weekly topics including goal setting and reducing sedentary behaviour in the form of Facebook posts and group video calls. Primary outcomes included feasibility and acceptability and secondary outcomes included psychological distress, quality of life (AQoL-6D), functioning, loneliness and physical activity (PA) with assessments conducted at baseline, post-intervention and 4-week follow-up. RESULTS: N = 11 participants were recruited and n = 10 (91%) completed the post-assessment questionnaires. High acceptability was observed and exploratory analysis from pre-post intervention found evidence of an effect on secondary outcomes. CONCLUSIONS: A mental health informed lifestyle program delivered online via Facebook appears feasible and well-accepted among older adults and may help to prevent some of the consequences of inactivity and social isolation associated with the pandemic. SO WHAT?: Online lifestyle interventions appear safe and may provide a scalable, cost-effective strategy for protecting the physical and mental health of older adults during the COVID-19 pandemic.

Quantifying pyrodiversity and its drivers.

Pyrodiversity or variation in spatio-temporal fire patterns is increasingly recognized as an important determinant of ecological pattern and process, yet no consensus surrounds how best to quantify the phenomenon and its drivers remain largely untested. We present a generalizable functional diversity approach for measuring pyrodiversity, which incorporates multiple fire regime traits and can be applied across scales. Further, we tested the socioecological drivers of pyrodiversity among forests of the western United States. Largely mediated by burn activity, pyrodiversity was positively associated with actual evapotranspiration, climate water deficit, wilderness designation, elevation and topographic roughness but negatively with human population density. These results indicate pyrodiversity is highest in productive areas with pronounced annual dry periods and minimal fire suppression. This work can facilitate future pyrodiversity studies including whether and how it begets biodiversity among taxa, regions and fire regimes.

Prolonged grief in refugees, parenting behaviour and children's mental health.

BACKGROUND: Many refugees experience bereavement, and as a result they suffer elevated rates of prolonged grief disorder. Evidence also indicates that elevated rates of psychological disturbance in refugee children can be associated with parental mental health. This study examined the extent to which prolonged grief disorder in refugees is associated with their parenting behaviour and in turn with their children's mental health. METHODS: This study recruited participants from the Building a New Life in Australia prospective cohort study of refugees admitted to Australia between October 2013 and February 2014. The current data were collected in 2015-2016 and comprised 1799 adults, as well as 411 children of the adult respondents. Adult refugees were assessed for trauma history, post-migration difficulties, harsh and warm parenting, probable prolonged grief disorder and posttraumatic stress disorder. Children were administered the Strengths and Difficulties Questionnaire. The current analyses on bereaved refugees comprise 110 caregivers and 178 children. RESULTS: In this cohort, 37% of bereaved refugees reported probable prolonged grief disorder. Path analysis indicated that caregivers' grief was directly associated with children's emotional difficulties. Caregiver warmth was associated with reduced emotional problems in children of refugees with minimal grief but associated with more emotional problems in caregivers with more severe grief. More harsh parenting was associated with children's conduct problems, and this was more evident in those with less severe grief. CONCLUSION: Severity of prolonged grief disorder is directly linked to refugee children's mental health. The association between parenting style, grief severity and children's mental health highlights that managing grief reactions in refugees can benefit both refugees and their children.

The Inter-Rater Consistency of Clinician Ratings of Posttraumatic Stress Disorder (PTSD) Therapy Content.

Effective communication between clinicians is essential for the success of mental health interventions in multidisciplinary contexts. This relies on a shared understanding of concepts, diagnoses and treatments. A major assumption of clinicians when discussing psychological treatments with each other is that both parties have a shared understanding of the theory, rationale and application of the respective technique. We aimed to determine to what extent there is inter-rater agreement between clinicians in describing the content of group therapy sessions. Pairs of clinicians, drawn from a large multidisciplinary team (13), were asked to provide ratings of the therapeutic content and emphasis of N = 154 group therapy sessions conducted during an intensive residential treatment program for post-traumatic stress disorder (PTSD). In most therapeutic content domains there was a moderate level of agreement between clinicians regarding session content (Cohen's Kappa 0.4 to 0.6), suggesting that clinicians have a broad shared understanding of therapeutic content, but that there are also frequent discordant understandings. The implications of these findings on multidisciplinary team communication, patient care and clinical handovers are discussed and directions for further research are outlined.

The well-being of medical students: A biopsychosocial approach.

OBJECTIVE: Mental health problems among medical students have been widely reported, but the predisposing and perpetuating factors and biological concomitants are poorly understood. Adopting a biopsychosocial approach, we studied well-being in a group of Australian medical students, focusing on sleep, autonomic and immune mechanisms, as well as mental, social and physical well-being, health-related behaviours, and daily functioning. METHODS: Fourth-year medical students (N = 151) completed comprehensive assessments, including laboratory-based and nocturnal autonomic monitoring via ambulatory bioharness, a psychiatric diagnostic interview, and questionnaires assessing sleep quality and psychosocial and physical well-being. A blood sample was taken to quantify the inflammatory marker C-reactive protein. Sleep, mood and activity was additionally monitored daily for 7 days. RESULTS: A sizable minority of students reported diminished physical, mental and psychosocial well-being. We also found concerning levels of sleep disturbance and social and occupational impairment in a subset of students. The strong co-occurrence of problems across symptom domains supported a biopsychosocial interdependence of health and well-being states. Maladaptive coping behaviours were apparent, notably hazardous alcohol consumption, which was associated with a clinically significant elevation in C-reactive protein levels (> 3 mg/L). We documented, for the first time, significantly diminished nocturnal heart rate variability in medical students with a mental health diagnosis. Nocturnal heart rate variability was strongly associated with sleep quality, daytime autonomic stress reactivity, as well as occupational and social functioning. CONCLUSION: Well-being is a multifaceted phenomenon firmly interlinked with sleep, autonomic and immune function, health behaviours and functional outcomes. Our novel findings supported a key role for nocturnal autonomic function in promoting sleep quality and mental well-being. Interventions could focus on sleep hygiene and health behaviours as a buffer for well-being and teach more adaptive strategies for coping with the stresses of medical training.

The Impact of Family Separation and Worry About Family on Psychological Adjustment in Refugees Resettled in Australia.

Few reliable predictors of postarrival psychological adjustment have been identified with regard to refugees once they arrive in their host country. We investigated the association between family separation and psychological symptoms in refugees resettled in Australia from 2013 to 2016. Participants were 1,495 adult refugees (M = 38.9 years, SD = 12.7) who participated in the Building a New Life in Australia population-based study across 4 years. Participants were assessed for psychological distress and posttraumatic stress symptoms (PTSS) using the Kessler Psychological Distress Scale (K6) and Posttraumatic Stress Disorder-8 (PTSD-8), respectively. We used latent class growth analysis (LCGA) to identify latent longitudinal trajectories and binary logistic regression to assess the contribution of family predictor variables toward PTSD-8 and K6 symptom trajectory class membership. The LCGA supported a four-class solution for PTSS, categorized as improving PTSS (18.4%), persistently high PTSS (11.5%), resilient PTSS (57.3%), and deteriorating PTSS (12.6%). For the K6, LCGA supported a four-class solution comprising classes categorized as persistently high psychological distress (PD; 7.0%), improving PD (17.3%), resilient PD (61.1%), and deteriorating PD (14.6%). Separation from family members did not independently predict the course of psychological symptoms; however, worry about family and friends contributed to the persistence of high PTSD-8 scores, OR = 1.75, and deteriorating K6 scores, OR = 1.57. The current findings suggest persistently high or worsening psychological symptom trajectories during the postsettlement phase may be marked by worry about family and friends, in addition to older age and female gender, rather than separation alone.

Obesity, physical activity and sleep quality in patients admitted to a posttraumatic stress inpatient ward.

OBJECTIVE: The aim of this paper was to cross-sectionally examine the association between physical health indicators and PTSD symptomatology. METHOD: A cross-sectional study was conducted among inpatients of a service related trauma-focused ward. Physical and mental health indicators including sleep quality, fitness, physical activity, body mass index and PTSD symptomatology were assessed. RESULTS: Among 60 inpatients, significant associations were found between sedentary time (r = 0.42; p < .001) and sleep quality (r = 0.40; p < .001) with PTSD symptomatology. The vast majority of inpatients (n = 56; 93%) were found to be either overweight or obese according to body mass index. CONCLUSION: Inpatients of a PTSD treatment facility had extremely high rates of obesity, physical inactivity, poor cardiorespiratory fitness and poor sleep quality. Sedentary behaviour is a modifiable risk factor associated with symptoms and physical health.

Longitudinal association between trust, psychological symptoms and community engagement in resettled refugees.

BACKGROUND: The mental health and social functioning of millions of forcibly displaced individuals worldwide represents a key public health priority for host governments. This is the first longitudinal study with a representative sample to examine the impact of interpersonal trust and psychological symptoms on community engagement in refugees. METHODS: Participants were 1894 resettled refugees, assessed within 6 months of receiving a permanent visa in Australia, and again 2-3 years later. Variables measured included post-traumatic stress disorder symptoms, depression/anxiety symptoms, interpersonal trust and engagement with refugees' own and other communities. RESULTS: A multilevel path analysis was conducted, with the final model evidencing good fit (Comparative Fit Index = 0.97, Tucker-Lewis Index = 0.89, Root Mean Square Error of Approximation = 0.05, Standardized Root-Mean-Square-Residual = 0.05). Findings revealed that high levels of depression symptoms were associated with lower subsequent engagement with refugees' own communities. In contrast, low levels of interpersonal trust were associated with lower engagement with the host community over the same timeframe. CONCLUSIONS: Findings point to differential pathways to social engagement in the medium-term post-resettlement. Results indicate that depression symptoms are linked to reduced engagement with one's own community, while interpersonal trust is implicated in engagement with the broader community in the host country. These findings have potentially important implications for policy and clinical practice, suggesting that clinical and support services should target psychological symptoms and interpersonal processes when fostering positive adaptation in resettled refugees.

Identifying distinctive psychological symptom profiles among a nationally representative sample of refugees resettled in Australia.

OBJECTIVE: The number of refugees worldwide is unprecedented in recent history. Little is known, however, about profiles of psychological symptoms following persecution and displacement. METHODS: This study reports on a latent class analysis that identified profiles of posttraumatic stress disorder (PTSD), depression and anxiety symptoms in a nationally representative sample of 1625 refugees in Australia. The association between specific symptom profiles, exposure to potentially traumatic events and post-migration stressors, and overall health and help-seeking was examined. RESULTS: Latent class analysis yielded an optimal five-class solution. These classes comprised the Pervasive Symptom class (19.2%), the High PTSD Symptom class (17.1%), the High Depression/Anxiety Symptom class (16.4%), the Moderate PTSD Symptom class (16.2%) and the Low Symptom class (31.1%). Participants in the symptomatic classes were more likely to be female, older and report greater post-migration stressors than those in the Low Symptom class. In addition, individuals in classes characterized by PTSD symptoms had been exposed to more types of potentially traumatic events. Membership in symptomatic classes was associated with poorer overall heath and greater help-seeking. CONCLUSION: Qualitatively distinct symptom profiles were observed in a nationally representative sample of refugees. In addition to a group of people who reported high symptoms across psychological disorders and may warrant clinical intervention, we identified two subclinical classes who may be missed by existing diagnostic classification systems. Post-migration stressors play an important role in influencing refugee symptom profiles over and above exposure to potentially traumatic events. Clinicians should consider specific symptom profiles and contextual factors when planning interventions with refugees.

The impact of post-traumatic stress disorder symptomatology on quality of life: The sentinel experience of anger, hypervigilance and restricted affect.

BACKGROUND: It is unclear which specific symptoms of post-traumatic stress disorder are related to poor perceived quality of life. OBJECTIVE: To investigate the influence of post-traumatic stress disorder symptomatology on quality of life in traumatic injury survivors. METHOD: Traumatic injury survivors completed questionnaires on post-traumatic stress disorder symptomatology and quality of life at 3 months ( n = 987), 12 months ( n = 862), 24 months ( n = 830) and 6 years ( n = 613) post trauma. RESULTS: Low quality of life was reported by 14.5% of injury survivors at 3 months and 8% at 6 years post event. The post-traumatic stress disorder symptom clusters that contributed most to poor perceived quality of life were numbing and arousal, the individual symptoms that contributed most were anger, hypervigilance and restricted affect. CONCLUSIONS: There was variability in the quality of life of traumatic injury survivors in the 6 years following trauma and a consistent proportion reported low quality of life. Early intervention to reduce anger, hypervigilance and restricted affect symptoms may provide a means to improving the quality of life of traumatic injury survivors.

Adjustment of refugee children and adolescents in Australia: outcomes from wave three of the Building a New Life in Australia study.

BACKGROUND: High-income countries like Australia play a vital role in resettling refugees from around the world, half of whom are children and adolescents. Informed by an ecological framework, this study examined the post-migration adjustment of refugee children and adolescents 2-3 years after arrival to Australia. We aimed to estimate the overall rate of adjustment among young refugees and explore associations with adjustment and factors across individual, family, school, and community domains, using a large and broadly representative sample. METHODS: Data were drawn from Wave 3 of the Building a New Life in Australia (BNLA) study, a nationally representative, longitudinal study of settlement among humanitarian migrants in Australia. Caregivers of refugee children aged 5-17 (N = 694 children and adolescents) were interviewed about their children's physical health and activity, school absenteeism and achievement, family structure and parenting style, and community and neighbourhood environment. Parent and child forms of the Strengths and Difficulties Questionnaire (SDQ) were completed by caregivers and older children to assess social and emotional adjustment. RESULTS: Sound adjustment according to the SDQ was observed regularly among young refugees, with 76-94% (across gender and age) falling within normative ranges. Comparison with community data for young people showed that young refugees had comparable or higher adjustment levels than generally seen in the community. However, young refugees as a group did report greater peer difficulties. Bivariate and multivariate linear regression analyses showed that better reported physical health and school achievement were associated with higher adjustment. Furthermore, higher school absenteeism and endorsement of a hostile parenting style were associated with lower adjustment. CONCLUSIONS: This is the first study to report on child psychosocial outcomes from the large, representative longitudinal BNLA study. Our findings indicate sound adjustment for the majority of young refugees resettled in Australia. Further research should examine the nature of associations between variables identified in this study. Overall, treating mental health problems early remains a priority in resettlement. Initiatives to enhance parental capability, physical health, school achievement and participation could assist to improve settlement outcomes for young refugees.