Vietnamese refugees with PTSD symptomatology: Intervention via a coping skills model

The current study of Vietnamese refugee students revealed that the majority had experienced multiple traumatic events and reported moderate to severe PTSD symptomatology. A stress intervention module (SIT), designed to treat rape victims, was introduced to determine its efficacy for the treatment of Vietnamese refugees with PTSD symptoms. Postintervention PTSD symptomatology was significantly reduced contrasted to virtually no change in symptomatology for the control subjects. Serious methodological concerns, e.g., selection bias, sample size, are highlighted in the paper. The current inquiry is essentially a pilot study. The paper is intended for heuristic value. Clinical literature is extant for culturally sensitive intervention approaches for this vulnerable population.     

War-related trauma and symptoms of posttraumatic stress disorder among adult Kosovar refugees

Since 1999, almost 16,000 Kosovar refugees have entered the United States. Few studies have investigated trauma and symptoms of posttraumatic stress disorder (PTSD) in this population. We conducted a caseworker-assisted survey of 129 Kosovar refugees (aged 18 to 79 years, 55% male). Of these individuals, 78 (60.5%) showed the likely presence of PTSD. The mean number of war-related traumatic events reported was 15 (SD = 4.5). Higher PTSD scores were associated with more traumatic events and female gender.     

Western conceptualizations and Eastern experience: a cross-cultural study of traumatic stress reactions among Tibetan refugees in India

This study investigated the nature and impact of traumatic experiences among Tibetan refugees in India. It explored the applicability of western conceptualizations of reactions to traumatic events among this cultural group. A randomly selected sample of refugee camp students was assessed on measures of psychological and physical complaints, and on impact as well as severity of traumatic experiences. Respondents had experienced multiple traumatic events. The majority reported ongoing health problems. More than half demonstrated symptoms of intrusion–avoidance. Those with more traumatic experiences reported more symptoms of anxiety and depression (psychologically and, particularly, somatically manifested). Cultural differences in types of experienced traumatic events and manifestations of distress are discussed, as are implications for cross-cultural trauma research using western conceptualizations and instruments.     

Assessing war trauma in refugees: properties of the Comprehensive Trauma Inventory-104

In this article, the authors describe the properties of the Comprehensive Trauma Inventory-104 (CTI-104), developed and designed empirically to improve assessment of traumatic war-related events. The mean number of events reported by 252 community dwelling Kurdish and Vietnamese refugees was 32 (SD=27) out of the 104 items. Internal and test-retest reliability was excellent, and the validity of the CTI-104 as a measure of war trauma was supported by its high correlation with standard measures of known outcomes of trauma. The CTI-104 is reliable and valid, and assesses a broader range of traumatic war-related events in a broader range of refugees than currently available instruments.     

Pathways from War Trauma to Posttraumatic Stress Symptoms Among Tamil Asylum Seekers, Refugees, and Immigrants

Path analysis was used to examine the antecedents of posttraumatic stress (PTS) symptoms in Tamil asylum-seekers, refugees, and immigrants in Australia. The Harvard Trauma Questionnaire and a postmigration living difficulties questionnaire were completed by 62 asylum-seekers, 30 refugees, and 104 immigrants who responded to a mail-out. Demographic characteristics, residency status, and measures of trauma and postmigration stress were fitted to a structural model in PTS symptoms. Premigration trauma exposure accounted for 20% of the variance of PTS symptoms. Postmigration stress contributed 14% of the variance. Although limited by sampling constraints and retrospective measurement, the study supports the notion that both traumatic and posttraumatic events contribute to the expression of PTS symptoms.     

The Impact of Interpersonal and Noninterpersonal Trauma on Psychological Symptoms in Refugees: The Moderating Role of Gender and Trauma Type

Research findings have documented a relationship between the number of types of traumatic events to which refugees were exposed and psychological disorders. It is unclear, however, if gender moderates the impact of trauma on refugee mental health. The participants in this study were 60 male and 31 female refugees and asylum‐seekers resettled in Australia. Participants had a mean age of 34.54 years (SD = 9.70), and were from a variety of countries including Iraq, Iran, and Sri Lanka. We conducted a multigroup path analysis to test if the relationship between psychological outcomes of exposure to trauma (posttraumatic stress disorder [PTSD] symptoms, symptoms of anxiety, and symptoms of depression) was different as a function of the type of traumatic exposure (interpersonal vs. noninterpersonal) or as a function of gender. We found a significant relationship between interpersonal trauma exposure and PTSD symptoms (β = .77) and anxiety symptoms (β = .32) in women, and a significant association between noninterpersonal trauma exposure and PTSD symptoms (β = .59), anxiety (β =.49), and depression symptoms (β = .32) in men. For men, the effect sizes of the relationship between exposure to specific types of noninterpersonal trauma and psychological symptoms ranged from d = 0.14 to 1.01; for exposure to interpersonal trauma, they ranged from d = ?0.53 to 0.43. For women, the effect sizes of the relationship between exposure to specific types of noninterpersonal trauma and psychological symptoms ranged from d = ?0.79 to 0.67; for exposure to interpersonal trauma, they ranged from d = ?0.09 to 1.46. These results suggested supporting refugees in their efforts to overcome the psychological impact of trauma, including the allocation of resources in clinical services to support the psychological recovery of refugees.     

Reduction in Posttraumatic Stress Symptoms in Congolese Refugees Practicing Transcendental Meditation

This matched single‐blind pilot study tested the effect of Transcendental Meditation® (TM) practice on symptoms of posttraumatic stress (PTS) in Congolese refugees. Urban refugees (N = 102) staying around Kampala, Uganda attended introductory meetings. After initial random assignment to the TM group, 30 refugees who revealed that they were unable to attend all meetings and were eliminated from the study. The remaining 21 TM group participants were then instructed in TM and matched with refugees in the control group on age, sex, and baseline scores on the Post‐traumatic Stress Disorder Checklist–Civilian (PCL‐C). All participants completed the PCL‐C measure of PTS symptoms at baseline, and 30‐day and 135‐day posttests. The PCL‐C scores in the control group trended upward. In contrast, the PCL‐C scores in the TM group went from 65 on average at baseline indicating severe PTS symptoms to below 30 on average after 30 days of TM practice, and remained low at 135 days. Effect size was high (d > 1.0). Compliance with TM practice was good; most reported regular practice throughout the study. There were no adverse events. All refugees who learned TM completed the study and were able to practice TM successfully, with subsequent substantial reduction in PTS symptoms.     

Adult trauma survivors and post-traumatic stress sequelae: An analysis of reexperiencing,avoidance, and arousal criteria

The relationship of traumatic events to DSM-III criteria symptoms for post-traumatic stress disorder was examined in a randomized community survey (N=2,364) of Los Angeles residents. Multivariate analysis of covariance revealed that both demographic factors and the type of traumatic event influenced respondents' reports of reexperiencing, avoidance, and arousal symptoms after the event.     

Replication and Extension of a Risk Profile for Amerasian Youth

The relationship between number of risk factors and symptoms of anxiety and depression was examined in a cohort of Vietnamese Amerasians, replicating a study done with a previous cohort. One hundred forty seven subjects awaiting U.S. placement completed the Hopkins Symptom Checklist, the Vietnamese Depression Scale, and a questionnaire which included items found to be risk factors for psychological distress among Amerasians. Number of risk factors was linearly related to symptoms of both depression and anxiety. Results are consistent with previous findings of the relationship between risk factors and symptoms of psychological distress. The profile may be helpful in anticipating which refugees may be at risk for future psychological distress, and thus be useful in preventively allocating scarce treatment resources.     

Posttraumatic Symptoms in South African Police Exposed to Violence

A study was undertaken with 55 Internal Stability Unit (ISU) members of the South African Police (SAP) to establish whether the situations under which they work, continuous and current, as opposed to prior, traumatic exposure, would result in a particular type of traumatic symptom constellation. The results indicated that the traumatic stressor of witnessing a traumatic event was predictive of the symptoms of intrusion. However, symptoms of intrusion were correlated with symptoms of avoidance, suggesting that avoidance may be a defensive response to intrusive phenomena which are a direct effect of exposure to violence. Various hypotheses were suggested to explain this phenomenon, focusing on the need for denial within a macho police culture and the particular features of the South African scenario.     

The indirect effect of somatic complaints on report of posttraumatic psychological symptomatology among Somali refugees

Somali refugees are a growing population of displaced persons at risk for considerable traumatic exposure and its subsequent psychological symptomatology. Two hypotheses were proposed to evaluate the relationships between somatic complaints and posttraumatic psychological symptoms in a community-based sample of 74 adult Somali participants. As hypothesized, traumatic exposure predicted increased symptoms of posttraumatic stress disorder (PTSD; r = .64, p < .01), depression (r = .31, p < .01), and anxiety (r = .38, p < .01) in the basal model. In evaluation of the second hypothesis, somatic complaints were found to have a statistically significant indirect effect on the predictive relationship between traumatic life events and mood disturbance, accounting for 9% of the variance in depression and 14% of the variance in anxiety. However, somatic complaints failed to have an indirect effect on the relationship between traumatic exposure and symptoms of PTSD. Post hoc analyses revealed that, consistent with research conducted with nonrefugee populations, PTSD had a statistically significant indirect effect that accounted for 13% of the variance in the relationship between trauma and somatic complaints. These findings provide preliminary data regarding the influence of somatic complaints on the self-reported psychological symptoms of internationally displaced Somali refugees.     

Social Support Moderates Effects of Natural Disaster Exposure on Depression and Posttraumatic Stress Disorder Symptoms: Effects for Displaced and Nondisplaced Residents

Social support is a known protective factor against the negative psychological impact of natural disasters. Most past research has examined how the effects of exposure to traumatic events influences whether someone meets diagnostic criteria for depression and posttraumatic stress disorder (PTSD); it has also suggested sequelae of disaster exposure depends on whether survivors are displaced from their homes. To capture the full range of the psychological impact of natural disasters, we examined the buffering effects of social support on depressive symptoms and cluster‐specific PTSD symptoms, with consideration of displacement status. In a survey conducted 18 to 24 months after Hurricane Katrina, 810 adults exposed to the disaster reported the number of Katrina‐related traumatic events experienced, perceived social support 2 months post‐Katrina, and cluster‐specific PTSD and depressive symptoms experienced since Katrina. Analyses assessed the moderating effects of social support and displacement and the conditional effects of displacement status. Social support significantly buffered the negative effect of Katrina‐related traumatic events on depressive symptoms, B = ?0.10, p = .001, and avoidance and arousal PTSD symptoms, B = ?0.02, p = .035 and B = ?0.02, p = .042, respectively. Three‐way interactions were nonsignificant. Conditional effects indicated social support buffered development of depressive symptoms across all residents; however, the moderating effects of support on avoidance and arousal symptoms only appeared significant for nondisplaced residents. Results highlight the protective effects of disaster‐related social support among nondisplaced individuals, and suggest displaced individuals may require more formal supports for PTSD symptom reduction following a natural disaster.     

Evaluation of a Trauma‐Focused Group Intervention for Unaccompanied Young Refugees: A Pilot Study

Recent research has shown that unaccompanied young refugees (UYR) encounter a wide range of traumatic events during preflight, flight, and resettlement. Although many UYR are resourceful, many develop posttraumatic stress symptoms (PTSS). However, only a small number of vulnerable UYR have access to trauma‐focused interventions. Trauma‐focused group interventions, adapted to the needs of UYR, may be one way of improving their mental health. A total of 29 male UYR between 14 and 18 years of age, mainly from Afghanistan, participated in the evaluation study of a trauma‐focused group intervention entitled Mein Weg (My Way ). The intervention included six sessions of psychoeducation, relaxation, trauma narrative, and cognitive restructuring. Pre–post comparisons of PTSS assessed by the Child and Adolescent Trauma Screen (CATS) were used. At study entry, participants endorsed, on average, eight traumatic events. After the group intervention, the participants reported significantly fewer overall PTSS preintervention mean = 27.6, SD  = 7.9; postintervention mean = 20.7, SD  = 6.3; t (28) = 4.2, p  = .001, Cohen's d  = 0.97. Improvement was especially pronounced in the domains of reexperiencing and avoidance, as well as negative alterations in cognitions and mood. There were 14 participants preintervention and 7 postintervention who fulfilled the PTSD criteria. This pilot study presented initial evidence of the efficacy of the trauma‐focused group intervention with regard to PTSS reduction.     

Prevalence of Traumatic Events and Peritraumatic Predictors of Posttraumatic Stress Symptoms in a Nonclinical Sample of College Students

This study investigated lifetime prevalence of traumatic events and posttraumatic stress disorder (PTSD) symptoms among 937 college students. Participants rated their lifetime experiences of traumatic events and, in response to their most stressful event, completed measures of objective stressor dimensions, PTSD, and peritraumatic reactions. Approximately 67% of respondents reported at least one traumatic event. An estimated 4% of the full sample (12% of traumatized individuals) met PTSD criteria within the past week. After controlling for vulnerability factors and objective characteristics, peritraumatic reactions remained strongly predictive of PTSD symptoms. Results are discussed with respect to immediate reactions to traumatic events as potential precursors of PTSD symptomatology.     

Quality of Life in Ethiopia's Street Youth at a Rehabilitation Center and the Association With Trauma

Quality of life (QOL) tends to be lower among the homeless than the general population, and traumatic events experienced on the streets have a negative impact on QOL. Low‐income countries face a high number of street youth, yet little research has been performed so far on QOL, trauma, and posttraumatic stress disorder (PTSD) among this group. This study aimed at examining the QOL of a sample of Ethiopian street youth within a rehabilitation program and at exploring whether the street youth have experienced traumatic events and show posttraumatic stress symptoms. We interviewed 84 street youths with the World Health Organization Quality of Life Questionnaire (WHOQOL‐BREF) and the Diagnostic Interview for Children and Adolescents (DICA). Mean QOL scores differed significantly between the groups assessed at the beginning and at the end of the program (Cohen's d = 0.48). Eighty‐three percent of the Ethiopian street youths had experienced traumatic events, and 25.0% met criteria for PTSD according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. QOL did not differ between those with and without PTSD symptoms. These findings show the high rate of traumatic events among Ethiopian street youth and the importance for rehabilitation programs that focus on improving QOL. The results of the study may have cultural limitations.     

Attachment Dimensions and Post‐traumatic Symptoms Following Interpersonal Traumas versus Impersonal Traumas in Young Adults in Taiwan

Greater risk of post‐traumatic stress disorder (PTSD) is seen in individuals exposed to interpersonal traumatic events. Based on an attachment perspective, interpersonal trauma exposure may activate one's attachment insecurity system and disrupt affect, behaviour and interpersonal function, which may in turn create more difficulties to cope with interpersonal traumas and exacerbate PTSD symptomatology. The present study examined whether attachment anxiety relative to attachment avoidance would be a stronger predictor of greater PTSD symptoms following interpersonal traumas versus impersonal traumas in a Taiwanese sample. One hundred and sixty‐two trauma‐exposed Taiwanese young adults completed the measures of symptoms of depression, anxiety and PTSD, and attachment anxiety and attachment avoidance. In this Taiwanese study, higher attachment anxiety was observed in individuals who were exposed to interpersonal traumas. The interpersonal trauma group reported greater PTSD symptoms than did the impersonal trauma group. Specifically, after controlling for age, occurrence of trauma and distress of trauma, attachment anxiety, but not attachment avoidance, predicted more PTSD total severity and avoidance symptoms in the interpersonal trauma group. The findings may be pertinent to attachment anxiety‐related hyperactivating strategies, as well as specific cultural values and a forbearance strategy applied to regulate traumatic distress in a collectivist society. Copyright © 2016 John Wiley & Sons, Ltd.     

Traumatic Grief and Traumatic Stress in Survivors 12 Years after the Genocide in Rwanda

The relationship between exposure to traumatic events and traumatic grief and the role of mediating and moderating variables [peritraumatic distress, post traumatic stress disorder (PTSD) symptoms and symptoms of depression] were studied in survivors of the genocide of Batutsi in Rwanda in 1994. One hundred and two survivors (70 women, mean age 45 ± 7.53 years) participated in this retrospective study. All of them had lost a member of their family. The severity of traumatic exposure (Comprehensive Trauma Inventory), peritraumatic distress (Peritraumatic Distress Inventory), current PTSD symptoms (PTSD Checklist), depressive symptoms (Beck Depression Inventory) and traumatic grief symptoms (Inventory of Traumatic Grief) was evaluated. A hierarchical multiple regression analysis was then conducted to examine the relative contribution of each variable to the symptoms of traumatic grief. The severity of traumatic exposure was related to traumatic grief symptoms (B = 0.06, R = 0.6, R² = 0.36 and ß = 0.6, t = 7.54, p = 0.00). The Baron and Kenny procedure (1986) (including three separate regressions), along with the Sobel test, was used to test mediation effects. Peritraumatic distress and PTSD symptoms may be mediating variables between traumatic exposure and traumatic grief. Traumatic grief is a complex but assessable entity, where previous distress and suffering result from both psychological trauma and the loss of a loved one. Copyright © 2011 John Wiley & Sons, Ltd.     

The relationship among cognitive schemas,job-related traumatic exposure,and posttraumatic stress disorder in journalists

American newspaper journalists (N = 906) participated in a study examining a cognitive mediational model for explaining the relationship between exposure to work-related traumatic events and work-related posttraumatic stress disorder (PTSD). Results indicated (a) greater exposure to work-related traumatic events was associated with work-related PTSD symptoms, as well as negative cognitive schemas; (b) cognitive beliefs partially accounted for PTSD symptoms, but the full cognitive mediational model was not supported. Implications include targeting interventions for journalists who experience traumatic stress and modifying theories about PTSD symptoms in journalists.     

Women's Sexual Desire,Trauma Exposure,and Posttraumatic Stress Disorder

Research suggests that posttraumatic stress disorder (PTSD) is associated with sexual dysfunction; however, there is a paucity of research examining the relations among trauma exposure, PTSD, and low sexual desire, specifically. Thus, the goal of the present study was to investigate whether women with hypoactive sexual desire disorder (HSDD; n = 132) were more likely to meet criteria for a diagnosis of current or lifetime PTSD relative to women with no sexual desire concerns (n = 137). We also sought to compare the type, frequency, and intensity of PTSD symptoms between the two groups. Finally, we examined whether women in the two groups were exposed to more, or different types of, potentially traumatic events. Compared to women with no sexual health concerns, women with HSDD were more likely to meet criteria for current PTSD, odds ratio (OR) = 5.50, 95% CI [1.18, 25.61]; and lifetime PTSD, OR = 2.78, 95% CI [1.56, 4.94]. Women in the HSDD group also had higher odds of meeting criteria for avoidance (5.10 times) and hyperarousal symptoms (4.48 times) and scored higher on measures of past-month PTSD symptom frequency, d = 0.62, and intensity, d = 0.57. No group differences were observed regarding reexperiencing symptoms, the associated features of PTSD, or type or frequency of exposure to potentially traumatic events. The findings indicate PTSD symptomatology may be a predisposing or perpetuating contributor to low sexual desire, and low sexual desire and PTSD may be related through an alteration in stress adaptability.     

Onset of Posttraumatic Stress Disorder and Major Depression Among Refugees and Voluntary Migrants to the United States

Although refugees are generally thought to be at increased risk for posttraumatic stress disorder (PTSD) and major depressive episode (MDE), few studies have compared onset of PTSD and MDE between refugees and voluntary migrants. Given differences in migration histories, onset should differ pre‐ and postmigration. The National Latino and Asian American Survey (NLAAS) is a national representative, complex dataset measuring psychiatric morbidity, mental health service use, and migration history among Latino and Asian immigrants to the United States. Of the 3,260 foreign‐born participants, 660 were refugees (a weighted proportion of 9.52%). Refugees were more likely to report a history of war‐related trauma, but reports of other traumatic events were similar. Premigration onset of PTSD was statistically higher for refugees than voluntary migrants, odds ratio (OR) = 4.86, 95% confidence interval (CI) [2.01, 11.76], where postmigration onset for PTSD was not, OR = 0.61, 95% CI [0.29, 1.28]; a similar pattern was found for MDE, OR = 1.98, 95% CI [1.11, 3.51]; and OR = 1.02, 95% CI [0.65, 1.62], respectively. Although refugees arrive in host countries with more pressing psychiatric needs, onset is comparable over time, suggesting that postmigration refugees and voluntary migrants may be best served by similar programs.