Key expressions of trauma-related distress in Cambodian children: A step toward culturally sensitive trauma assessment and intervention.

More than half of all children in Cambodia experience direct abuse and over 70% experience other traumatic events, which significantly increase their risks for a range of physical and mental health problems. Additionally, Cambodian children face longstanding sociopolitical, intergenerational, and cultural factors that compound the impact of other trauma. As a result, rates of posttraumatic stress symptoms among Cambodian youth are high. However, care providers often rely on Western-based nosology that does not account for culturally specific expressions of trauma. A greater understanding of culturally-salient expressions of distress can help inform diagnostic assessment accuracy and treatment effectiveness and monitoring. The current study utilized a qualitative design to interview 30 Cambodian caregivers of children with trauma experiences and 30 Cambodian children (ages 10-13 years) with trauma experiences to identify key local expressions of trauma. Findings reveal certain PTSD symptoms and culturally-specific frequent and severe trauma-related problems for Cambodian children and domains of functioning impacted by trauma. Certain symptoms seem particularly important to evaluate in this group, such as anger, physical complaints (e.g., headache and palpitations), and cognitive-focused complaints (in particular, "thinking too much"). All caregivers and children reported physical health as impacted by trauma-related problems, highlighting a particularly salient domain of functioning for this population. Expressions of distress explored in the current study are discussed in the context of assessment and intervention development to inform diagnostic and clinical efforts for those working with trauma-exposed Cambodian children.

Measurement nonequivalence of the Clinician-Administered PTSD Scale by race/ethnicity: Implications for quantifying posttraumatic stress disorder severity.

Research studies suggest racial/ethnic differences in posttraumatic stress disorder (PTSD) diagnosis and symptom severity. Few studies to date, however, have examined the extent to which these findings are due to differences in measurement properties of existing PTSD scales. This study examined measurement equivalence across race/ethnicity in the Clinician-Administered PTSD Scale (CAPS) by testing for differential item functioning (DIF) in the item response theory (IRT) framework. Participants were 506 trauma-exposed women (M = 39.41 years, SD = 8.94) who participated in the National Drug Abuse Treatment Clinical Trials Network Women and Trauma Study. PTSD severity score estimates were improved upon as part of IRT estimation incorporating symptom "weights" (i.e., factor loadings) and group-specific DIF. Six symptoms from the CAPS showed DIF, with the majority of differences in measurement driven by White/African American and White/Latina differences, particularly for (a) avoidance of thoughts and (b) a sense of foreshortened future. Despite both racial/ethnic minority groups being slightly (not significantly) more likely to receive a PTSD diagnosis, African Americans (p = .014; Cohen's d = -.22) and Latinas (p < .001; d = -.73) had significantly lower PTSD severity scores than Whites as estimated under IRT with group-specific DIF. Examination of PTSD severity scores based on symptom counts revealed these differences were either dampened (White/Latina difference d = -.39) or entirely negated (White/African American difference d = -.08). The findings suggest the importance of considering differences in symptom relevance across race/ethnicity and their impact on capturing symptom severity parallel to diagnostic criteria. Implications for clinical practice are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Changes in social status and postmigration mental health among West African immigrants.

Immigration comes with rapid changes in social status that have effects on mental health. Research with nonimmigrant populations has identified relevant social status indicators, but these indicators are not sufficient to address changes that are uniquely relevant to immigrants. This study aimed to identify social status indicators that change during the process of migration and to examine their association with distress using variable- and person-centered analyses. We used data from an archival dataset of West African immigrants in New York City. Pre- and postmigration changes across work, marriage, language use, urbanism, and residency status were used to assess whether positive, negative, or no change in social status had occurred. Changes in social status indicators across migration were predicted to account for variance in mental health outcomes (i.e., anxiety, depression, somatization, and posttraumatic stress) beyond premigration potentially traumatic events (PTE). Several social status indicators predicted wellbeing in this population and accounted for variance in distress beyond premigration PTEs. Ward's method clustering suggested that 3 distinct social status profiles were characterized primarily by changes in work and marriage. The cluster with the greatest positive changes in work was almost all female and had the highest depression scores. These findings suggest that the impact of change in social status across immigration is not uniform across social status indicators. Additionally, changing gender roles across migration appear to have an influential impact on postmigration social status and mental health. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The Mental Health and Well-Being of Canadian Indigenous and Non-Indigenous Women Abused by Intimate Partners.

Intimate partner violence (IPV), mental health, disabilities, and child abuse history were examined for 292 Indigenous compared with 295 non-Indigenous Canadian women. IPV was assessed by the Composite Abuse Scale and mental health by the Symptom Checklist-10, Center for Epidemiological Studies-Depression 10, the Posttraumatic Stress Disorder (PTSD) Checklist, and Quality of Life Questionnaire. Scores did not differ nor were they in the clinical ranges for the two groups. In a MANCOVA on the mental health/well-being scales, with IPV severity as a covariate, only disability was significantly associated with more severe mental health symptoms. Suggestions for service providers are presented.

Early Sexual Experiences, Mental Health, and Risk Behavior among Black Non-Hispanic and Hispanic / Latino Men Who Have Sex with Men (MSM).

Black and Latino men who have sex with men (MSM) are disproportionately affected by childhood sexual abuse (CSA). Investigating these histories is often confounded by underreporting and varied definitions of abuse. Unrecognized abuse may manifest in unhealthy ways, specifically psychological distress, substance use, and high-risk sexual behaviors. Black and Hispanic/Latino MSM in New York City discussed formative sexual experiences in in-person interviews. Eligible men reported a sexual experience occurring before age 16 with a man or woman 18 or older at the time. Among interviewees (n = 61), men living with HIV were significantly younger at the time of their first sexual experience with a male partner compared to HIV-negative men. Approximately half of interviewees (47.5%) scored at or above the diagnostic cutoff for post-traumatic stress disorder (PTSD). Hispanic/Latino men had increased odds of scoring at or above the diagnostic cutoff for PTSD compared to Black non-Hispanic men. Further, nearly half of interviewees (46%) scored at or above the diagnostic cutoff for harmful drug use or possible drug dependence. Study findings have implications for future research using an indirect approach to uncovering potential sexual abuse during childhood, and associations with adult health outcomes.

Resilience and anxiety or depression among resettled Bhutanese adults in the United States.

BACKGROUND: Resilience, or an individual's positive response in managing life's adversities, is of increasing interest in addressing the mental health disparities in refugees. Although the link between stressful life events and poor mental health is established, research on the role of resilience on the mental health of refugees is limited. AIMS: This study assessed the association between resilience and anxiety or depression in resettled Bhutanese adults in Western Massachusetts. METHODS: A cross-sectional survey was conducted among 225 Bhutanese (men: 113, women: 112) refugees aged 20-65 residing in Massachusetts. Resilience was measured with the 25-item Wagnild and Young's Resilience Scale including two constructs as follows: a 17-item 'personal competence' that measures self-reliance, independence, determination, resourcefulness, mastery and perseverance and an 8-item 'acceptance of self and life' that measures adaptability, flexibility and a balanced perspective of life. Higher total scores indicate greater resilience. The Hopkins Symptom Checklist-25 was used to measure anxiety (10-item) and depression (15-item) with a cutoff mean score of ⩾1.75 for moderate to severe symptoms. Associations of resilience with anxiety or depression scores were assessed using multiple-linear and logistic regression analyses. RESULTS: The proportion of participants with above threshold anxiety and depression were 34.2% and 24%, respectively. Resilience was inversely associated with both anxiety (beta for 1 unit change in resilience scores: ß = -0.026; p = .037) and depression (ß = -0.036, p = .041). 'Personal competence' resilience was inversely associated with both anxiety (ß = -0.041 p = .017) and depression (ß = -0.058, p = .019), but 'acceptance of self and life' resilience was not. Participants with the highest tertile of resilience scores had a significantly decreased risk of anxiety (ORs (95% CI): 0.13 (0.04-0.40)) and depression (0.16 (0.04-0.60)). CONCLUSION: Higher resilience was associated with reduced anxiety and depression among Bhutanese with personal competence resilience accounting for most of the effects. These findings suggest the potential targets for mental-health intervention to improve resilience in refugees.

Mental health issues among indigenous communities and the role of traditional medicine.

INTRODUCTION: Mental health in indigenous communities is a relevant issue for the World Health Organization (WHO). These communities are supposed to live in a pure, clean and intact environment. Their real condition is far different from the imaginary; they are vulnerable populations living in difficult areas, exposed to pollution, located far from the health services, exposed to several market operations conducted to extract natural resources, facing criminal groups or illegal exploitation of land resources. These factors may have an impact on mental health of indigenous population. METHODS: We reviewed all papers available on PubMed, EMBASE and The Cochrane Library until December 2018. We focused on those factors affecting the changes from a traditional to a post-modern society and reviewed data available on stress-related issues, mental distress affecting indigenous/aboriginal communities and the role of Traditional Medicine (TM). We reviewed articles from different countries hosting indigenous communities. RESULTS: The incidence of mental distress and related phenomena (e.g. collective suicide, alcoholism and violence) among indigenous populations is affected by political and socio-economic variables. The mental health of these populations is poorly studied and described even if mental illness indicators are somewhat alarming. TM still seems to have a role in supporting affected people and may reduce deficiencies due to poor access to medical insurance/coverage, psychiatry and psychotherapy. It would be helpful to combine TM and modern medicine in a healthcare model to face indigenous populations' health needs. CONCLUSION: This review confirms the impact of societal changes, environmental threats and exploitation of natural resources on the mental health of indigenous populations. Global Mental Health needs to deal with the health needs of indigenous populations as well as psychiatry needs to develop new categories to describe psychopathology related to social variance as recently proposed by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5).

A literature review of the psychological status of asylum-seeking children: implications for nursing practice.

Europe is in the midst of a large-scale migration crisis, which has implications for healthcare provision for asylum-seeking children and families. The authors set out to identify the psychological status of asylum-seeking children and highlight their needs. A search of three electronic databases was carried out, resulting in 15 studies. Data show that asylum-seeking children appear to experience many mental health difficulties, including post-traumatic stress disorder, depression, self-harm, sleep disturbance and behavioural difficulties. The daily living situation includes a range of psychological stressors, such as lack of space and control; fear of deportation; feelings of inadequacy and hopelessness; poor parental mental health; lack of recreational facilities; communication issues; and financial worries. Since many asylum-seeking children have experienced past trauma, hospitalisation and healthcare encounters may trigger traumatic memories and cause further distress. Awareness of the psychological impact of the situation on children and families may help nurses to provide empathetic, sensitive and culturally competent care.

Mental Health Status and Service Assessment for Adult Syrian Refugees Resettled in Metropolitan Atlanta: A Cross-Sectional Survey.

Because little is known about the mental health status of Syrian refugees in the United States, we conducted a survey among a convenience sample of those resettled in Atlanta between March 2011 and 2017. Though home visits, we delivered a questionnaire including standardized instruments (HSCL25 and PTSD-8) to assess symptoms of anxiety, depression and Posttraumatic Stress Disorder. We found high rates of anxiety (60%), depression (44%) and Posttraumatic Stress Disorder (84%) symptoms; however, only 20% of participants had seen a mental health professional. Reported reasons for not seeking professional help were lack of transportation and access to information. Findings of this survey indicate the high burden of mental health symptoms and the need for services to the study population. A longitudinal study with a larger sample size would improve the understanding of mental health needs and resilience factors of Syrian refugees resettled in the US.

Prevalence of Possible Mental Disorders in Syrian Refugees Resettling in the United States Screened at Primary Care.

Little is known about mental health problems among newly arrived Syrian refugees in the US. It is important to determine the prevalence of common consequences of exposure to trauma and high stress, and provide needed interventions, as these conditions if untreated, can be detrimental to mental and physical health. Adult Syrian refugees (n = 157, 47.1% women, 52.9% men) were screened at one-month mandatory primary care health visit for Posttraumatic Stress Disorder (PTSD), anxiety and depression using PTSD Checklist, and Hopkins Symptoms Checklist. Prevalence of possible diagnoses was high for PTSD (32.2%), anxiety (40.3%), and depression (47.7%). Possible prevalence of depression and anxiety were higher among women, but there was no gender difference for possible PTSD. We found a high prevalence of possible psychiatric disorders related to trauma and stress among Syrian refugees newly resettled in the US. Due to the high prevalence and feasibility of brief screening tools in primary care facilities, we recommend mental health screening during primary care health visits for resettled Syrian refugees.

Culturally Sensitive Assessment of Anxious-Depressive Distress in Vietnam: Avoiding Category Truncation.

The present study investigated what complaints are prominent in psychologically distressed Vietnamese in Vietnam beyond standard symptoms assessed by Western diagnostic instruments for anxiety and depression. To form the initial Vietnamese Symptom and Cultural Syndrome Addendum (VN SSA), we reviewed the literature, consulted experts, and conducted focus groups. The preliminary VN SSA was then used in a general survey (N = 1004) of five provinces in Vietnam. We found that the VN SSA items were highly and significantly correlated with a measure of anxious-depressive psychopathology (a composite measure of the General Anxiety Disorder-7; Posttraumatic Diagnostic Scale; and Patient Health Questionnaire-9). The VN SSA item most highly correlated to anxious-depressive psychopathology was "thinking a lot" ( r = .54), reported by 15.8% of the sample. Many other symptoms in the addendum also were prominent, such as orthostatic dizziness (i.e., dizziness upon standing up; r = .41), reported by 22.9% of the sample. By way of comparison, somatic complaints more typically assessed to profile Western anxious-depressive distress, such as palpitations, were less prominent, as evidenced by being less strongly correlated to Western psychiatric symptoms and being less frequent (e.g., palpitations: r = .31, 7.1% of the sample). Study results suggest that to avoid category truncation when profiling anxious-depressive distress among Vietnamese that items other than those in standard psychopathology measures should also be assessed.

A Review of the Historical, Criminological, and Theoretical Understandings of the Cambodian American Population: A Call for More Comprehensive Research.

The collective view of Asian Americans as model minorities is evident with the extensive amount of statistical data showing support for the academic and socioeconomic success of Asian Americans in the United States. This perception, however, often presents an inaccurate portrayal of Asian Americans, in general, as it overlooks many of the difficulties and hardships experienced by Asian American ethnic groups such as Southeast Asians. Within this group, Cambodian Americans are at the highest risk for experiencing socioeconomic hardships, behavioral health problems, substance use disorders, and contact with the criminal justice system, with deportation also being a prevailing issue. Unfortunately, research in this area is scant and contemporary research on Cambodian Americans has several limitations. To begin to address this issue, the present article merges information from existing research on this population from a sociohistorical, criminological, and theoretical standpoint to call for more comprehensive research on Cambodian Americans.

Maternal depression in Syrian refugee women recently moved to Canada: a preliminary study.

BACKGROUND: Refugee women are almost five times more likely to develop postpartum depression than Canadian-born women. This can be attributed to various difficulties they faced before coming to Canada as well as during resettlement. Moreover, refugee women usually face many obstacles when accessing health services, including language and cultural barriers, as well as unique help-seeking behaviors that are influenced by various cultural and practical factors. There has been a recent, rapid influx of Syrian refugees to Canada, and many of them are childbearing women. However, little is known about the experiences that these women have encountered pre- and post-resettlement, and their perceptions of mental health issues. Thus, there is an urgent need to understand refugee women's experiences of having a baby in Canada from a mental health perspective. METHODS: A mixed methods research design included 12 Syrian refugee women who migrated to Saskatoon in 2015-16 and who were either pregnant or 1 year postpartum. The data were collected during a single focus group discussion and a structured questionnaire. RESULTS: Our results showed that more than half of participants have depressive symptoms, half of them have anxiety symptoms, and one sixth have PTSD symptoms. Three major themes emerged from the qualitative data: 1) Understanding of maternal depression; 2) Protective factors for mental health; and 3) Barriers to mental health services. CONCLUSIONS: Maternal depression is an important feature in Syrian refugee women recently resettled in Canada. Reuniting these women with their families and engaging them in culturally appropriate support programs may improve their mental health outcomes.

[Psychiatric care of refugees in Africa and the Middle East : Challenges and solutions]. / Psychiatrische Versorgung von Flüchtlingen in Afrika und dem Nahen Osten : Herausforderungen und Lösungsansätze.

Violence, flight, famine, and natural disasters as well as the absence of a psychosocial healthcare system are major psychological burdens for refugees. The level of provision of mental healthcare is particularly low in developing countries. Internally displaced people and refugees place high demands on the healthcare system because they often suffer from psychiatric disorders, such as depression, posttraumatic stress disorder, and substance use disorders. We present first initiatives to improve psychiatric care in refugee camps in Ethiopia, Kenya, and Sudan. Moreover, we provide first insights into a project based in Northern Iraq and Germany aimed at the treatment of people who were severely traumatized by the terror regime of the so-called Islamic State (IS).

Towards a culturally appropriate trauma assessment in a South African Zulu community.

OBJECTIVE: To develop a culture specific screening tool for trauma, and to determine whether it would significantly increase the probability of eliciting traumatic events and associated symptoms when added to a Western diagnostic tool for trauma. METHOD: A convenience sample of 1 hundred Zulu speaking volunteers was recruited in the North-Eastern KwaZulu-Natal region of South Africa. A demographic questionnaire, the Post Traumatic Stress Disorder (PTSD) section of the Structured Clinical Interview for DSM Disorders, Axis I, Research Version (SCID-I RV), and a Zulu Culture-Specific Trauma Experience Questionnaire (Z-CTEQ) designed for this study were administered to the participants. RESULTS: As measured by the SCID-I RV, the rates of exposure to traumatic events as well as the lifetime prevalence of PTSD were relatively high, at 32% and 24%, respectively. The use of the 10-item Z-CTEQ, when added to the SCID, increased the rate at which traumatic events were elicited by 19.4%. The additional traumatic events elicited were culture-specific in nature and were significantly associated with PTSD (p < .0001). The Z-CTEQ also elicited culture-specific attributions for traumatic events, which could prove beneficial for therapeutic interventions. The Z-CTEQ was found to have acceptable internal reliability, with a Cronbach's alpha of 0.78. The construct and discriminant validity of the Z-CTEQ were supported by several significant correlations between the SCID and the Z-CTEQ and between the additional traumatic events elicited and PTSD. CONCLUSION: Despite some identified limitations, our findings suggest that the Z-CTEQ can enhance the assessment and management of trauma in the study population. (PsycINFO Database Record

Ethnoracial differences in PTSD symptoms and trauma-related cognitions in treatment-seeking active duty military personnel for PTSD.

OBJECTIVE: It is uncertain whether ethnoracial factors should be considered by clinicians assessing and treating posttraumatic stress disorder (PTSD) among service members. The purpose of this study was to shed light on ethnoracial variation in the presentation of PTSD symptoms, trauma-related cognitions, and emotions among treatment-seeking active duty military personnel. METHOD: Participants were 303 male active duty military members with PTSD participating in a clinical trial (60% were self-identified as White, 19% as African American, and 21% as Hispanic/Latino). In the parent study, participants completed a baseline assessment that included clinician-administered and self-report measures of PTSD, trauma-related cognitions, and emotions. RESULTS: Multivariate hierarchical regression models were used to examine ethnoracial differences in these variables, covarying age, education, military grade, combat exposure, and exposure to other potentially traumatic events. Hispanic/Latino and African American participants reported more reexperiencing symptoms, more fear, and more guilt and numbing than White participants. All effect sizes were in the small to medium range. CONCLUSIONS: These findings suggest ethnoracial variation in PTSD symptom burden and posttraumatic cognitions among treatment-seeking service members with PTSD. Attending to cultural factors related to differences in PTSD presentation and cognitive coping strategies during the assessment and treatment process could increase rapport and lead to more comprehensive trauma processing. (PsycINFO Database Record

Racial Differences in Posttraumatic Stress Disorder Vulnerability Following Hurricane Katrina Among a Sample of Adult Cigarette Smokers from New Orleans.

Although blacks are more likely than whites to experience posttraumatic stress disorder (PTSD) after a natural disaster, the reasons for this disparity are unclear. This study explores whether race is associated with PTSD after adjusting for differences in preexisting vulnerabilities, exposure to stressors, and loss of social support due to Hurricane Katrina using a representative sample of 279 black and white adult current and past smokers who were present when Hurricane Katrina struck, and identified it as the most traumatic event in their lifetime. Multiple logistic regression models evaluated whether differential vulnerability (pre-hurricane physical and mental health functioning, and education level), differential exposure to hurricane-related stressors, and loss of social support deterioration reduced the association of race with PTSD. Blacks were more likely than whites to screen positive for PTSD (49 vs. 39 %, respectively, p = 0.030). Although blacks reported greater pre-hurricane vulnerability (worse mental health functioning and lower educational attainment) and hurricane-related stressor exposure and had less social support after the hurricane, only pre-hurricane mental health functioning attenuated the association of race with screening positive for PTSD. Thus, racial differences in pre-hurricane functioning, particularly poorer mental health, may partially explain racial disparities in PTSD after natural disasters, such as Hurricane Katrina. Future studies should examine these associations prospectively using representative cohorts of black and whites and include measures of residential segregation and discrimination, which may further our understanding of racial disparities in PTSD after a natural disaster.

Post-traumatic Stress Disorder Symptoms Among People Living with HIV/AIDS in Rural China.

Among people living with HIV/AIDS (PLHA), the occurrence of post-traumatic stress disorder (PTSD) symptoms associated with HIV diagnosis is a common problem. This study examined HIV diagnosis-related PTSD symptoms and its associated factors among PLHA in rural China. We used baseline data from a randomized controlled trial conducted in Anhui Province, China. Surveys of 522 PLHA were conducted via computer-assisted personal interview method. PTSD symptoms were measured based on re-experiencing, avoidance and arousal of the day of HIV diagnosis. Association between PTSD symptoms and demographic characteristics, physical and social functioning were assessed by multiple regression analysis and structural equation modeling. Social functioning exhibited a direct association with HIV diagnosis-related PTSD symptoms, and also mediated the association between PTSD symptoms and age, family income, and physical functioning. The study findings underscore the importance of developing interventions that alleviate PTSD symptoms and improve social functioning among PLHA in rural China.