Mental health outcomes in Syrian refugees: A systematic review.

BACKGROUND: Syria is the main country of origin for refugees in the world. The prevalence of mental disorders in this population is high, but there is a lack of more comprehensive data on mental health issues in this population. AIM: This study aims to review the literature for mental health outcomes in Syrian refugees. METHODS: We performed a systematic quantitative literature review of original observational studies indexed on the MEDLINE via PubMed, Embase, Web of Science, PsycINFO, LILACS, and SciELO databases with quantitative data reporting mental health outcomes in Syrian refugees. A descriptive analysis was conducted, and the quality of the included studies was assessed using an adaptation from The National Institutes of Health (NIH) quality assessment tool for observational studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. RESULTS: A total of 64 studies were included. The majority were published between 2019 and 2020, and focused on the prevalence of post-traumatic stress disorder (PTSD), depression, and anxiety, with a wide range of variations. Other outcomes were difficulties in the post-migration period and promotive factors for mental health, such as resilience, positive coping strategies, and psychosocial well-being. CONCLUSIONS: High prevalence rates of mental disorders were observed, as well as risk factors for their occurrence. Studies showed a very high variability of prevalence rates and heterogeneity in methodologies. There is a need for research focusing on other determinants and specific necessities for mental health, especially in the post-resettlement period.

Identifying posttraumatic stress disorder staging from clinical and sociodemographic features: a proof-of-concept study using a machine learning approach.

This proof-of-concept study aimed to investigate the viability of a predictive model to support posttraumatic stress disorder (PTSD) staging. We performed a naturalistic, cross-sectional study at two Brazilian centers: the Psychological Trauma Research and Treatment (NET-Trauma) Program at Universidade Federal of Rio Grande do Sul, and the Program for Research and Care on Violence and PTSD (PROVE), at Universidade Federal of São Paulo. Five supervised machine-learning algorithms were tested: Elastic Net, Gradient Boosting Machine, Random Forest, Support Vector Machine, and C5.0, using clinical (Clinician-Administered PTSD Scale version 5) and sociodemographic features. A hundred and twelve patients were enrolled (61 from NET-Trauma and 51 from PROVE). We found a model with four classes suitable for the PTSD staging, with best performance metrics using the C5.0 algorithm to CAPS-5 15-items plus sociodemographic features, with an accuracy of 65.6% for the train dataset and 52.9% for the test dataset (both significant). The number of symptoms, CAPS-5 total score, global severity score, and presence of current/previous trauma events appear as main features to predict PTSD staging. This is the first study to evaluate staging in PTSD with machine learning algorithms using accessible clinical and sociodemographic features, which may be used in future research.

Relationship between childhood trauma, parental bonding, and defensive styles and psychiatric symptoms in adult life.

INTRODUCTION: A relationship between different types of childhood trauma, parental care, and defensive styles and development of psychiatric symptoms in adulthood is proposed in this study. Understanding the nature of this association is essential to assist psychotherapists who treat patients with a history of past trauma. This study aims to examine the associations between childhood trauma, parental bonding, and defensive styles and current symptoms in adult patients who sought care at an analytical psychotherapy clinic. METHODS: The sample comprised 197 patients from an analytically oriented psychotherapy clinic. Participants responded to four self-report instruments that assessed, respectively, presence and frequency of several types of early trauma, type of parental attachment, styles of defenses, and current symptoms encompassing a wide variety of psychopathological syndromes. RESULTS: Only 5% of patients reported not having experienced any traumatic experience in childhood. Several traumas such as emotional and physical abuse, emotional neglect, and physical neglect showed positive and significant associations with several dimensions of current symptoms, and also with parental bonding and defensive styles. When analyzed together with the other variables, defensive styles explained the level of psychological suffering caused by the symptoms. CONCLUSIONS: This study offers additional support for understanding the associations between childhood trauma, parental bonding styles, and defense styles and the psychiatric symptoms of patients in analytically oriented psychotherapy.

Association between anger expression and attempted suicide at a general emergency hospital in the south of Brazil.

INTRODUCTION: Suicide is one of the leading causes of death in the world. For every person who commits suicide, twenty or more have attempted to take their own lives. The emotional state of anger is often associated with suicidal behavior. However, this association needs to be further clarified. OBJECTIVES: This study sought to investigate the profiles of traits and expressions of anger in inpatients admitted to a general emergency hospital after surviving a suicide attempt. METHODS: In this case-control study, a sample of 28 suicide survivors was matched for sex, age, and educational level with 56 controls. The State-Trait Anger Expression Inventory-2 was used to measure anger traits and expression. RESULTS: Suicide survivors scored higher for anger traits and expression and lower for anger control than the control group. They also had lower levels of state anger and willingness to express anger verbally than the control group. CONCLUSIONS: Patients who attempted suicide and had high scores for anger expression (in and out) are inclined to have extreme difficulty in interpersonal relationships and rigidity towards change and are at higher risk of developing psychopathologies.

The use of machine learning techniques in trauma-related disorders: a systematic review.

Establishing the diagnosis of trauma-related disorders such as Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) have always been a challenge in clinical practice and in academic research, due to clinical and biological heterogeneity. Machine learning (ML) techniques can be applied to improve classification of disorders, to predict outcomes or to determine person-specific treatment selection. We aim to review the existing literature on the use of machine learning techniques in the assessment of subjects with ASD or PTSD. We systematically searched PubMed, Embase and Web of Science for articles published in any language up to May 2019. We found 806 abstracts and included 49 studies in our review. Most of the included studies used multiple levels of biological data to predict risk factors or to identify early symptoms related to PTSD. Other studies used ML classification techniques to distinguish individuals with ASD or PTSD from other psychiatric disorder or from trauma-exposed and healthy controls. We also found studies that attempted to define outcome profiles using clustering techniques and studies that assessed the relationship among symptoms using network analysis. Finally, we proposed a quality assessment in this review, evaluating methodological and technical features on machine learning studies. We concluded that etiologic and clinical heterogeneity of ASD/PTSD patients is suitable to machine learning techniques and a major challenge for the future is to use it in clinical practice for the benefit of patients in an individual level.

Relationship between childhood trauma, parental bonding, and defensive styles and psychiatric symptoms in adult life

Abstract Introduction A relationship between different types of childhood trauma, parental care, and defensive styles and development of psychiatric symptoms in adulthood is proposed in this study. Understanding the nature of this association is essential to assist psychotherapists who treat patients with a history of past trauma. This study aims to examine the associations between childhood trauma, parental bonding, and defensive styles and current symptoms in adult patients who sought care at an analytical psychotherapy clinic. Methods The sample comprised 197 patients from an analytically oriented psychotherapy clinic. Participants responded to four self-report instruments that assessed, respectively, presence and frequency of several types of early trauma, type of parental attachment, styles of defenses, and current symptoms encompassing a wide variety of psychopathological syndromes. Results Only 5% of patients reported not having experienced any traumatic experience in childhood. Several traumas such as emotional and physical abuse, emotional neglect, and physical neglect showed positive and significant associations with several dimensions of current symptoms, and also with parental bonding and defensive styles. When analyzed together with the other variables, defensive styles explained the level of psychological suffering caused by the symptoms. Conclusions This study offers additional support for understanding the associations between childhood trauma, parental bonding styles, and defense styles and the psychiatric symptoms of patients in analytically oriented psychotherapy.

Trauma infantil e manifestações histéricas na atualidade: uma revisão da literatura / Child trauma and hysterical manifestations today: a literature review

As reações corporais e emocionais sentidas pelos pacientes com manifestações histéricas podem atingir tamanha intensidade, a ponto de prejudicar sua vida social, familiar e laboral. O trabalho parte dos seguintes questionamentos: como são as manifestações histéricas na atualidade? Qual a compreensão sobre a histeria na literatura da área ao longo do tempo? O objetivo é descrever aspectos teóricos sobre a histeria e o trauma infantil, articulando-os com a clínica atual. Foi desenvolvida uma revisão da literatura por meio do método narrativo. Os resultados encontrados foram 106 estudos nos últimos 6 anos (Bireme e Dialnet), sendo que, de 2017 em diante, houve um decréscimo nas publicações científicas sobre o tema. Apesar de a categoria psicopatológica da histeria ter desaparecido dos manuais de transtornos mentais, na clínica atual as manifestações histéricas são facilmente confundidas com outros transtornos (depressivos, dissociativos e distúrbio borderline). As manifestações somáticas aparecem no corpo para comunicar eventos traumáticos não contidos pelo aparelho psíquico. Conclui-se que as manifestações histéricas seguem presentes nos dias de hoje, e o corpo tende a ser uma via de expressão somática. No contexto da relação entre sintomas histéricos e traumas vivenciados na infância, a psicoterapia ocupa lugar de destaque, promovendo ressignificações para tais eventos traumáticos.(AU)

The bodily and emotional reactions felt by patients with hysterical manifestations can reach such intensity as to harm their social, family and work life, causing several losses for the individual. The study starts from the following questions: how are the hysterical manifestations today? What about understanding hysteria in the literature of the area over time? The objective is to describe theoretical aspects of hysteria and childhood trauma, in conjunction with the current clinic. A literature review using the narrative method was developed. The results found were 106 studies in the last 6 years (Bireme and Dialnet), and as of 2017 there is a decrease in scientific publications on the topic. Although the psychopathological category of hysteria has disappeared from the manuals of mental disorders, nowadays in the clinic the hysterical manifestations are easily confused with other disorders (depressive, dissociative and borderline). Somatic manifestations appear in the body to communicate traumatic events not contained by the psychic apparatus. It is concluded that the hysterical manifestations are still present today, and the body tends to be an important way of expressing symptoms through the somatic path. In the context of the relationship between hysterical symptoms and childhood trauma, psychotherapy occupies a prominent place, promoting reframing for such traumatic events.(AU)

Las reacciones corporales y emocionales que sienten los pacientes con manifestaciones histéricas pueden alcanzar tal intensidad como para dañar su vida social, familiar y laboral, causando varias pérdidas para el individuo. El estudio parte de las siguientes preguntas: ¿Cómo son hoy las manifestaciones histéricas? ¿Cuál es la comprensión de la histeria en la literatura de la zona a lo largo del tiempo? El objetivo es describir aspectos teóricos de la histeria y el trauma infantil, en conjunto con la clínica actual. Se ha elaborado una revisión de la literatura utilizando el método narrativo. Los resultados encontrados fueron 106 estudios en los últimos 6 años (Bireme y Dialnet), y a partir de 2017 hubo una disminución en las publicaciones científicas sobre el tema. Aunque la categoría psicopatológica de histeria ha desaparecido de los manuales de trastornos mentales, hoy en día en la clínica las manifestaciones histéricas se confunden fácilmente con otros trastornos (depresivo, disociativo y borderline). Las manifestaciones somáticas aparecen en el cuerpo para comunicar eventos traumáticos no contenidos por el aparato psíquico. Se concluye que las manifestaciones histéricas todavía están presentes hoy en día, y el cuerpo tiende a ser una forma importante de expresar los síntomas a través de las vías somáticas. En el contexto de la relación entre los síntomas histéricos y el trauma vivido en la infancia, la psicoterapia ocupa un lugar destacado, promoviendo replanteamiento para tales eventos traumáticos.(AU)