Coping with the long-term impact of civil strife: A grief-centered analysis of Tamil Sri Lankan communities affected by ethnopolitical conflict.

Limited research has examined coping mechanisms in response to chronic war-related stressors, as opposed to war-exposure trauma. The current study sought to investigate the types of losses experienced by communities affected by the Sri Lankan conflict, how participants responded to their losses, and what coping mechanisms they employed. Data consisted of interviews from two independent investigations conducted following the end of the conflict in Northern Sri Lanka (total N = 103). Interview transcripts were analyzed using a directed content analysis approach. Participants most frequently described experiencing material loss and loss of loved ones. Relatedly, participants commonly reported experiencing ambiguous loss, that is, living with the uncertainty of their loved one's death. These losses were particularly pronounced by gender, with women experiencing higher rates of loss. Common coping strategies included support-seeking, including informal support from social networks and religion, and formal mental health services. Additionally, participants described a range of longer term coping strategies from establishing a future-oriented cognitive style to a sense of helplessness and resignation. The findings shed light on how conflict-affected groups cope with profound loss. We provide recommendations for how such findings can inform grief-related clinical interventions.

Examining associations between personal growth initiative and subjective trajectories of life satisfaction among survivors of ethnopolitical violence in Rwanda and Sri Lanka.

Does personal growth initiative (PGI)-the tendency to be proactive about one's personal development-impact adaptive beliefs about life quality among survivors of mass violence, such as ethnopolitical warfare or genocidal violence? One-hundred-and-twenty-three survivors of the 1994 genocide against the Tutsi in Rwanda and 179 Tamil individuals affected by the civil war in Sri Lanka completed assessments of PGI, satisfaction with one's past life, current life satisfaction, and anticipated future life satisfaction. High levels of PGI were associated with an adaptive inclining trajectory of life satisfaction (Past < Present < Future) in both samples. These results indicate that PGI is associated with adaptive beliefs about one's identity and well-being among war-affected populations, and supports future interventions targeting PGI among those communities.

Association Rule Learning Is an Easy and Efficient Method for Identifying Profiles of Traumas and Stressors that Predict Psychopathology in Disaster Survivors: The Example of Sri Lanka.

Research indicates that psychopathology in disaster survivors is a function of both experienced trauma and stressful life events. However, such studies are of limited utility to practitioners who are about to go into a new post-disaster setting as (1) most of them do not indicate which specific traumas and stressors are especially likely to lead to psychopathology; and (2) each disaster is characterized by its own unique traumas and stressors, which means that practitioners have to first collect their own data on common traumas, stressors and symptoms of psychopathology prior to planning any interventions. An easy-to-use and easy-to-interpret data analytical method that allows one to identify profiles of trauma and stressors that predict psychopathology would be of great utility to practitioners working in post-disaster contexts. We propose that association rule learning (ARL), a big data mining technique, is such a method. We demonstrate the technique by applying it to data from 337 survivors of the Sri Lankan civil war who completed the Penn/RESIST/Peradeniya War Problems Questionnaire (PRPWPQ), a comprehensive, culturally-valid measure of experienced trauma, stressful life events, anxiety and depression. ARL analysis revealed five profiles of traumas and stressors that predicted the presence of some anxiety, three profiles that predicted the presence of severe anxiety, four profiles that predicted the presence of some depression and five profiles that predicted the presence of severe depression. ARL allows one to identify context-specific associations between specific traumas, stressors and psychological distress, and can be of great utility to practitioners who wish to efficiently analyze data that they have collected, understand the output of that analysis, and use it to provide psychosocial aid to those who most need it in post-disaster settings.

Network models can help focus research on the role of culture and context in psychopathology, but don't discount latent variable models.

Borsboom et al. correctly note that the use of latent variable models in cross-cultural research has resulted in a futile search for universal, biological causes of psychopathology; however, this is not an inevitable outcome of such models. While network analytic approaches require further development, network models have the potential to better elucidate the role of cultural and contextual variables related to psychopathology.

The importance of positive need fulfillment: Evidence from a sample of war-affected Sri Lankans.

There has been growing interest in understanding the psychological and social-environmental factors that facilitate adaptive functioning in populations affected by ethnopolitical warfare. In the current study, we tested the hypothesis that a brief measure incorporating local idioms of positive need fulfilment would predict functioning in a war-affected Sri Lankan population above and beyond psychopathology when controlling for demographic variables and current life stressors. A brief measure of positive need fulfillment was derived from qualitative data and administered to a sample of 163 Sri Lankans affected by the civil war. Positive need fulfillment was found to uniquely predict functioning after controlling for age, war-related life problems, and psychopathology as assessed by the Penn-RESIST-Peradeniya War Problems Questionnaire. These findings highlight the importance of both basic need support and the fostering of agency in addition to addressing mental health needs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Measuring Depression in a Non-Western War-Affected Displaced Population: Measurement Equivalence of the Beck Depression Inventory.

Depression is commonly seen in survivors of conflict and disaster across the world. There is a dearth of research on the validity of commonly used measures of depression in these populations. Measurements of depression that are used in multiple contexts need to meet measurement equivalence, i.e., the instrument measures the same construct in the same manner across different groups. The Beck Depression Inventory (BDI) was administered to female trauma survivors in the United States (n = 268) and female survivors of war in Sri Lanka (n = 149). Three metrics of measurement equivalence-structural, metric, and scalar-were examined. Two- and three-factor structures of the BDI that have been identified in other populations did not provide a good fit for our data. However, a bifactor model revealed a similar general distress dimension across populations, but dissimilar secondary dimensions or subfactors. The Sri Lankan subfactor comprised of predominantly somatic symptoms and the United States subfactor comprised of cognitive and somatic symptoms. While intercepts of individual BDI items differed, their differences seem to be offsetting. Total BDI scores across these two populations are roughly comparable, although caution is recommended when interpreting them. Making comparisons on subscales is not recommended.

Post-conflict struggles as networks of problems: A network analysis of trauma, daily stressors and psychological distress among Sri Lankan war survivors.

A growing body of literature indicates that the mental distress experienced by survivors of war is a function of both experienced trauma and stressful life events. However, the majority of these studies are limited in that they 1) employ models of psychological distress that emphasize underlying latent constructs and do not allow researchers to examine the unique associations between particular symptoms and various stressors; and 2) use one or more measures that were not developed for that particular context and thus may exclude key traumas, stressful life events and symptoms of psychopathology. The current study addresses both these limitations by 1) using a novel conceptual model, network analysis, which assumes that symptoms covary with each other not because they stem from a latent construct, but rather because they represent meaningful relationships between the symptoms; and 2) employing a locally developed measure of experienced trauma, stressful life problems and symptoms of psychopathology. Over the course of 2009-2011, 337 survivors of the Sri Lankan civil war were administered the Penn-RESIST-Peradeniya War Problems Questionnaire (PRPWPQ). Network analysis revealed that symptoms of psychopathology, problems pertaining to lack of basic needs, and social problems were central to the network relative to experienced trauma and other types of problems. After controlling for shared associations, social problems in particular were the most central, significantly more so than traumatic events and family problems. Several particular traumatic events, stressful life events and symptoms of psychopathology that were central to the network were also identified. Discussion emphasizes the utility of such network models to researchers and practitioners determining how to spend limited resources in the most impactful way possible.

Primum Non Nocere (First Do No Harm): Symptom Worsening and Improvement in Female Assault Victims After Prolonged Exposure for PTSD.

(Reprinted with permission from Depression and Anxiety 2014; 31:412-419).

The protective function of personal growth initiative among a genocide-affected population in Rwanda.

The aim of the current study was to investigate the extent to which individual differences in personal growth initiative (PGI) were associated with lower reports of functional impairment of daily activities among a genocide-affected population in Rwanda. PGI measures an individual's motivation to develop as a person and the extent to which he or she is active in setting goals that work toward achieving self-improvement. We found that PGI was negatively associated with functional impairment when controlling for depression, posttraumatic stress disorder, and other demographic factors. Our results suggest that PGI may constitute an important mindset for facilitating adaptive functioning in the aftermath of adversity and in the midst of psychological distress, and as such they might have practical applications for the development of intervention programs.

Trauma Characteristics and Posttraumatic Stress Disorder among Adolescent Survivors of Childhood Sexual Abuse.

This study examined the relationship between the characteristics of childhood sexual abuse (CSA) and the severity of consequent posttraumatic stress disorder (PTSD), depression, suicidal ideation, and substance use in a sample of 83 female adolescents aged 13-18 years seeking treatment for PTSD. Nearly two-thirds of the sample (60.7%, n = 51) reported the perpetrator of the CSA was a relative. A large portion (40.5%, n = 34) of the sample reported being victimized once, while almost a quarter of the sample reported chronic victimization (23.8%, n = 20). PTSD and depression scores were in the clinical range, whereas reported levels of suicidal ideation and substance use were low. The frequency of victimizations was associated with suicidal ideation. Contrary to expectation, CSA characteristics including trauma type, perpetrator relationship, and duration of abuse were unrelated to PTSD severity, depressive symptoms, or substance abuse.

Primum non nocere (first do no harm): symptom worsening and improvement in female assault victims after prolonged exposure for PTSD.

BACKGROUND: Prolonged Exposure (PE) therapy is an efficacious treatment for PTSD; despite this, many clinicians do not utilize it due to concerns it could cause patient decompensation. METHOD: Data were pooled from four published well-controlled studies of female assault survivors with chronic PTSD (n = 361) who were randomly assigned to PE, waitlist (WL), or another psychotherapy, including cognitive processing therapy (CPT), Eye Movement and Desensitization Reprocessing (EMDR), or the combination of PE plus stress inoculation training (SIT) or PE plus cognitive restructuring. PTSD and depression severity scores were converted to categorical outcomes to evaluate the proportion of participants who showed reliable symptom change (both reliable worsening and reliable improvement). RESULTS: The majority of participants completing one of the active treatments showed reliable improvement on both PTSD and depression compared to WL. Among treatment participants in general, as well as those who received PE, reliable PTSD worsening was nonexistent and the rate of reliable worsening of depression was low. There were no differences on any outcome measures among treatments. By comparison, participants in WL had higher rates of reliable symptom worsening for both PTSD and depression. Potential alternative explanations were also evaluated. CONCLUSIONS: PE and a number of other empirically supported therapies are efficacious and safe treatments for PTSD, reducing the frequency of which symptom worsening occurs in the absence of treatment.

The factor structure of the CES-D in a sample of Rwandan genocide survivors.

BACKGROUND: Past research suggests that culture shapes the way psychopathology is experienced and expressed. Standard psychiatric assessment instruments may therefore not capture the same underlying constructs in different contexts. The present study investigated the factor structure of a standard depression scale in a sample of Rwandan genocide survivors. METHODS: One hundred ninety six Rwandan adults provided socio-demographic information and completed the Center for Epidemiological Studies-Depression scale (CES-D), one of the most widely used self-report instruments assessing depressive symptoms, as part of a larger study on well-being and mental health in Rwanda. RESULTS: A two-factor solution provided the best fit for these CES-D data. The first factor corresponded to general depressive symptoms (including depressed affect, somatic symptoms, and interpersonal concerns) and explained 37.20% of the variance. The second factor included items assessing positive affect and explained 8.68% of the variance. CONCLUSIONS: The two-factor solution found in the present study deviates from the commonly reported four-factor structure, but is consistent with studies showing that depressed affect and somatic symptoms may not be experienced as distinct in certain non-Western and minority cultural groups.

Are culturally specific measures of trauma-related anxiety and depression needed? The case of Sri Lanka.

The hypothesis that psychometric instruments incorporating local idioms of distress predict functional impairment in a non-Western, war-affected population above and beyond translations of already established instruments was tested. Exploratory factor analysis was conducted on the War-Related Psychological and Behavioral Problems section of the Penn/RESIST/Peradeniya War Problems Questionnaire (PRPWPQ; N. Jayawickreme, Jayawickreme, Goonasekera, & Foa, 2009), a measure that incorporates local idioms of distress, using data from 197 individuals living in Northern and Eastern Sri Lanka. Three subscales--Anxiety, Depression, and Negative Perception--were identified. Regression analyses were conducted to test whether these 3 subscales better predicted functional impairment than the PTSD Symptom Scale-Self Report (PSS; Foa, Riggs, Dancu, & Rothbaum, 1993) and the Beck Depression Inventory (BDI; Beck & Steer, 1987), both widely used self-report measures of posttraumatic stress disorder and depression, respectively. Two of the 3 subscales from the PRPWPQ--Anxiety and Depression--were significantly associated with higher rates of functional impairment after controlling for age, the PSS and the BDI. After the inclusion of PRPWPQ, the PSS and the BDI did not significantly contribute to the final regression model predicting functional impairment. These findings suggest that the scores of measures with local idioms of distress have incremental validity in non-Western war-affected populations, predicting functional impairment above and beyond translations of established self-report measures that have been developed in the Western world.

Race-specific associations between trauma cognitions and symptoms of alcohol dependence in individuals with comorbid PTSD and alcohol dependence.

Posttraumatic Stress Disorder (PTSD) changes the way people think about themselves, others, and the safety of the world. These cognitions may play a role in alcohol dependence, where alcohol dependence is maintained as an attempt to manage posttraumatic anxiety. The current study examined black-white differences in various PTSD cognitions and their relationship to symptoms of alcohol dependence in a dually diagnosed sample (N=167). Analyses revealed racial differences in trauma cognitions and their impact on symptoms of alcohol dependence, suggesting that trauma cognitions are more strongly associated with adverse consequences of drinking and alcohol craving severity among African Americans than European Americans. Additional relationships between ethnic identification and trauma-related cognitions are described and theoretical and clinical implications of these findings are discussed.

Gender-specific associations between trauma cognitions, alcohol cravings, and alcohol-related consequences in individuals with comorbid PTSD and alcohol dependence.

The current study examined gender-specific associations between trauma cognitions, alcohol cravings and alcohol-related consequences in individuals with dually diagnosed PTSD and alcohol dependence (AD). Participants (N = 167) had entered a treatment study for concurrent PTSD and AD; baseline information was collected from participants about PTSD-related cognitions in three areas: (a) Negative Cognitions About Self, (b) Negative Cognitions About the World, and (c) Self-Blame. Information was also collected on two aspects of AD: alcohol cravings and consequences of AD. Gender differences were examined while controlling for PTSD severity. The results indicate that Negative Cognitions About Self are significantly related to alcohol cravings in men but not women, and that interpersonal consequences of AD are significantly related to Self-Blame in women but not in men. These findings suggest that for individuals with comorbid PTSD and AD, psychotherapeutic interventions that focus on reducing trauma-related cognitions are likely to reduce alcohol cravings in men and relational problems in women.

Collective narcissism and its social consequences.

This article introduces the concept of collective narcissism--an emotional investment in an unrealistic belief about the in group's greatness--aiming to explain how feelings about an ingroup shape a tendency to aggress against outgroups. The results of 5 studies indicate that collective, but not individual, narcissism predicts intergroup aggressiveness. Collective narcissism is related to high private and low public collective self-esteem and low implicit group esteem. It predicts perceived threat from outgroups, unwillingness to forgive outgroups, preference for military aggression over and above social dominance orientation, right-wing authoritarianism, and blind patriotism. The relationship between collective narcissism and aggressiveness is mediated by perceived threat from outgroups and perceived insult to the ingroup. In sum, the results indicate that collective narcissism is a form of high but ambivalent group esteem related to sensitivity to threats to the ingroup's image and retaliatory aggression.