Predicting positive mental health in internally displaced persons in Indonesia: the roles of economic improvement and exposure to violent conflict.

Positive mental health, rather than just the absence of mental illness, is rarely investigated among the internally displaced persons (IDPs) affected by violent conflict in low-income countries. The purpose of this study was to investigate a model that could explain the interrelationship between factors contributing to positive mental health in displaced populations. In a longitudinal study we examine poverty, exposure to traumatic events and the change of material well-being after one year. We collected data in two consecutive years (2005 and 2006) from a community-based sample of IDPs in Ambon, Indonesia, through face-to-face structured interviews with consenting adults. Participants of this study were IDPs lived in Ambon during the violent conflict period. We interviewed 471 IDPs in the first year and reinterviewed 399 (85%) of the same subjects in the second year. The IDPs possessed good sense of coherence and subjective well-being. Our final model, which was generated by the use of structural equation modeling, fits the data well (χ(2) = 52.51, df = 45, p = .21, CFI = .99, RMSEA = .019). Exposure to violent conflict had a negative impact on IDPs' mental health initially and better economic conditions improved it (r = -.30 and .29 respectively). Mental health status one year previously was a strong predictor of future mental health, followed by individual economic growth in the past year (r = .43 and .29 respectively). On a group level the IDPs were resilient and adaptive to survive in adverse living conditions after devastating violent conflict, and the economic improvement contributed to it.

Perceived current needs, psychological distress and functional impairment in a war-affected setting: a cross-sectional study in South Sudan.

OBJECTIVES: To examine the current perceived needs of the general population in a war-affected setting, and to study the influence of perceived needs on the participants' mental health status and functional impairment across genders. METHODS: A cross-sectional community survey (n=464) was conducted in war-affected South Sudan. Three regression models were analysed. Perceived needs were assessed with the Humanitarian Emergency Settings Perceived Needs Scale. Psychological distress was measured with the General Health Questionnaire and level of functioning by the Short Form Health Survey (SF-12). RESULTS: The most frequently expressed needs were related to drinking water, alcohol and drug use in the community and access to sanitation facilities. No gender differences were found regarding the level of perceived needs or the number of traumatic events. Higher level of perceived needs significantly predicted psychological distress and lower level of functioning even when numbers of experienced trauma events were taken into account. CONCLUSIONS: The associations of higher level of needs and trauma experiences, on the one hand, and negative health outcomes on the other, necessitate a greater integration of interventions directed towards the population's perceived needs and mental health, particularly for those who have been exposed to trauma.

Predictors of acculturative hassles among Vietnamese refugees in Norway: Results from a long-term longitudinal study.

We investigated acculturative hassles in a community cohort of Vietnamese refugees in Norway (n = 61), exploring cross-sectional data and longitudinal predictors of acculturative hassles using data from their arrival in Norway in 1982 (T1), with follow up in 1985 (T2) and in 2005-2006 (T3). To our knowledge, this is the first longitudinal study of predictors of acculturative hassles in a refugee population. Results indicated that more communication problems and less Norwegian language competence were related to most hassles at T3. Higher psychological distress, lower quality of life, lower self-reported state of health, and less education at T3 were associated with higher levels of hassles at T3. More psychological distress at T2 and less education at arrival (T1) were significant predictors for more acculturative hassles at T3. These data suggest that addressing psychological distress during the early phase in a resettlement country may promote long-term refugee adjustment and, in particular, reduce exposure to acculturative hassles.

Community attitudes and social distance towards the mentally ill in South Sudan: a survey from a post-conflict setting with no mental health services.

PURPOSE: This study investigates attitudes and social distance towards the mentally ill in a post-conflict, low-income country. METHODS: A cross-sectional community survey (n = 1,200) was conducted in South Sudan. Associations between various sociodemographic variables and attitudes toward/social distance from the mentally ill were investigated. RESULTS: The regression analysis showed that lower levels of education were positively associated with social distance, and Christian or Muslim beliefs, compared with traditional beliefs, were negatively associated with social distance. Familiarity with mental illness or psychological distress was not significantly associated with social distance. Participants who endorsed community-oriented attitudes (rather than hospital/drug-oriented attitudes) about health care for the mentally ill were more likely show a decreased social distance. Participants who believed that the mentally ill were dangerous had higher scores on the social distance scale. CONCLUSIONS: A high level of stigma towards the mentally ill exists in South Sudan, especially in the rural areas. Alongside efforts to build up mental health services in South Sudan, the existing stigma needs to be addressed. Information regarding the role of the community both in preventing mental illnesses and in service delivery should be prioritised.

What are the risk factors for the comorbidity of posttraumatic stress disorder and depression in a war-affected population? A cross-sectional community study in South Sudan.

BACKGROUND: Limited data exists on the association of war trauma with comorbid posttraumatic stress disorder (PTSD)-depression in the general population of low-income countries. The present study aimed to evaluate socioeconomic and trauma-related risk factors associated with PTSD, depression, and PTSD-depression comorbidity in the population of Greater Bahr el Ghazal States, South Sudan. METHODS: In this cross-sectional community study (n=1200) we applied the Harvard Trauma Questionnaire (HTQ) and MINI International Neuropsychiatric Interview (MINI) to investigate the prevalence of PTSD, depression, and PTSD-depression comorbidity. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, sociodemographic, and socioeconomic factors. RESULTS: PTSD only was found in 331 (28%) and depression only in 75 (6.4%) of the study population. One hundred and twelve (9.5%) of the participants had PTSD-depression comorbid diagnosis. Exposure to traumatic events and socioeconomic disadvantage were significantly associated with having PTSD or PTSD-depression comorbidity but not with depression. Participants with a comorbid condition were more likely to be socioeconomic disadvantaged, have experienced more traumatic events, and showed higher level of psychological distress than participants with PTSD or depression alone. CONCLUSIONS: In individuals exposed to war trauma, attention should be given to those who may fulfill criteria for a diagnosis of both PTSD and depression.

Posttraumatic growth, depressive symptoms, posttraumatic stress symptoms, post-migration stressors and quality of life in multi-traumatized psychiatric outpatients with a refugee background in Norway.

BACKGROUND: Psychiatric outpatients with a refugee background have often been exposed to a variety of potentially traumatizing events, with numerous negative consequences for their mental health and quality of life. However, some patients also report positive personal changes, posttraumatic growth, related to these potentially traumatic events. This study describes posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, post-migration stressors, and their association with quality of life in an outpatient psychiatric population with a refugee background in Norway. METHODS: Fifty five psychiatric outpatients with a refugee background participated in a cross-sectional study using clinical interviews to measure psychopathology (SCID-PTSD, MINI), and four self-report instruments measuring posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, and quality of life (PTGI-SF, IES-R, HSCL-25-depression scale, and WHOQOL-Bref) as well as measures of social integration, social network and employment status. RESULTS: All patients reported some degree of posttraumatic growth, while only 31% reported greater amounts of growth. Eighty percent of the patients had posttraumatic stress symptoms above the cut-off point, and 93% reported clinical levels of depressive symptoms. Quality of life in the four domains of the WHOQOL-Bref levels were low, well below the threshold for the'life satisfaction' standard proposed by Cummins. A hierarchic regression model including depressive symptoms, posttraumatic stress symptoms, posttraumatic growth, and unemployment explained 56% of the total variance found in the psychological health domain of the WHOQOL-Bref scale. Posttraumatic growth made the strongest contribution to the model, greater than posttraumatic stress symptoms or depressive symptoms. Post-migration stressors like unemployment, weak social network and poor social integration were moderately negatively correlated with posttraumatic growth and quality of life, and positively correlated with psychopathological symptoms. Sixty percent of the outpatients were unemployed. CONCLUSIONS: Multi-traumatized refugees in outpatient clinics reported both symptoms of psychopathology and posttraumatic growth after exposure to multiple traumatic events. Symptoms of psychopathology were negatively related to the quality of life, and positively related to post-migration stressors such as unemployment, weak social network and poor social integration. Posttraumatic growth was positively associated with quality of life, and negatively associated with post-migration stressors. Hierarchical regression modeling showed that posttraumatic growth explained more of the variance in quality of life than did posttraumatic stress symptoms, depressive symptoms or unemployment. It may therefore be necessary to address both positive changes and psychopathological symptoms when assessing and treating multi-traumatized outpatients with a refugee background.

Perceived needs, self-reported health and disability among displaced persons during an armed conflict in Nepal.

BACKGROUND: Most internally displaced persons (IDPs) live in low-income countries and have experienced war. Few studies have assessed their psychosocial needs and disability. We carried out a comprehensive assessment of perceived needs, self-reported health, and disability among IDPs in Nepal and examined factors associated with disability. METHOD: A cross-sectional survey among 290 IDPs in Nepal was conducted between June and July 2003. We used the World Health Organization's Disability Assessment Schedule-II (WHO-DAS II) with additional local items to assess disability symptoms and a separate checklist to identify their perceived needs. Depression and anxiety symptoms were measured using the Hopkins Symptom Check List (HSCL-25), while the Posttraumatic Stress Disorder Checklist Civilian Version (PCL-C) was used to assess Posttraumatic Stress Disorder (PTSD) symptoms. RESULTS: Different perceived needs such as financial help (70%), housing (40%), food and education for their children (20%) were expressed by the IDPs. Self-reported health status was strongly associated with distress and disability scores. Factors independently associated with disability were higher age, self-reported health, depression, anxiety but not PTSD. There was good correlation between WHO-DAS II and the locally identified items of disability measurement. CONCLUSIONS: The reporting of findings only about psychiatric symptoms is insufficient in studying the mental health of displaced and potentially traumatized populations living in low-income countries. Assessments of perceived needs and factors associated with disability give a more comprehensive understanding of the underlying needs among crisis populations, and this can inform intervention programs. Depression and anxiety should be treated effectively to avoid disability.

Gender differences in factors associated with psychological distress among immigrants from low- and middle-income countries--findings from the Oslo Health Study.

OBJECTIVE: Despite the high rate of migration from low- and middle-income countries to high-income countries, there is still a lack of comprehensive studies of gender-specific differences in psychological distress in a diverse group of immigrants. We compared psychological distress between male and female immigrants from low- and middle-income countries living in Oslo, and identified factors associated with distress for men and women, separately. METHOD: A cross-sectional survey with self-administered questionnaires was conducted among 1536 immigrants from low- and middle-income countries living in Oslo. The Hopkins Symptom Checklist (HSCL-10) was used to measure psychological distress. Data on their sociodemographic characteristics, negative and traumatic life events, and social integration and possible discrimination in the Norwegian society were also collected. RESULTS: One-fourth of the study population was found to be psychologically distressed, with almost equal levels among men and women. Lack of salaried job and recent negative life events were independently associated with psychological distress for both genders. Furthermore, experience of denial of job and past traumatic experiences were other associated negative factors among men, while visits made by Norwegians appeared as a protective factor against distress among men. Older age, Middle East background, living without a partner, and experiencing denial of housing were other associated negative factors among women. CONCLUSION: Our findings show that, except for adverse living conditions, there are gender differences with regard to factors associated with psychological distress among immigrants living in Oslo. Such gender issues are relevant for assisting immigrants in the integration process as well as for future research in migration and health.