Gender and Place of Settlement as Predictors of Perceived Social Support, PTSD, and Insomnia among Internally Displaced Adolescents in North-East Nigeria

Previous research has shown that gender affects social support and post-traumatic stress disorders (PTSD). The present study explores the main and interaction effects of gender and place of settlement on social support, PTSD symptoms, and insomnia in internally displaced adolescents (IDAs) in North-east of Nigeria. A stratified sampling method was used to select 109 participants from IDAs living in the camp, while 27 additional IDAs were purposively recruited from those living in the host community. Participants completed measures of Harvard Trauma Questionnaire Part-II, Insomnia Severity Index, and Crisis Support. No significant effects of gender on perceived social support, PTSDs, and insomnia were observed. Place of settlement had a significant effect on social support, with IDAs living in the camp having a higher mean score, while place of settlement had no significant effects on PTSD and insomnia. A significant interaction effect of gender and place of settlements on insomnia was found, with males living in the community having a higher mean score than their female counterparts, as well as both males and females in the camp. In conclusion, there is a need to understand male IDAs who reside in non-camp settings better, including the nature of their challenges, the outcomes they desire, and the limitations they experienced.

Adaptation and Validation of the Harvard Trauma Questionnaire (HTQ) and PTSD Checklist-5 (PCL-5) with Indian Women from Slums Reporting Gender-Based Violence

Background: Despite high rates of gender-based violence (GBV) in India, culturally sensitive measures that examine universal and culturally relevant trauma reactions are lacking. Although the Harvard Trauma Questionnaire (HTQ) has been used in India, no study has adapted the measure in full for use with this population. This study describes the adaptation, validation, and results from the adapted HTQ, containing the PTSD Checklist-5 (PCL-5), for Indian women from slums reporting GBV. Method: This study used the adaptation framework proposed by the HTQ measure developers. The adapted HTQ contained a (1) trauma screen relevant for stressors faced by Indian women from slums, (2) description of the index trauma, (3) description of any ongoing stressors, (4) universal trauma reactions (i.e., PTSD measured by the PCL-5), and culturally relevant trauma reactions (i.e., idioms of distress measured by a scale developed for the study). This measure was piloted on 111 women from Indian slums in face-to-face interviews. Trauma characteristics, types of ongoing stressors, and psychometric properties of the PCL-5 and idioms of distress scale were explored. These scales were validated against measures of depression (PHQ-9), anxiety (GAD-7), and somatic complaints (PHQ-9). Results: The majority of participants (77%) reported physical beatings, 18% reported unwanted sexual touch, and 28.8% reported infidelity as the primary emotional abuse. Further, 96.7% of GBV was perpetrated by partner or family member and over half reported ongoing stressors (e.g., poverty-related strain). The PCL-5 embedded in the HTQ yielded good internal consistency (Cronbach’s alpha=.88) as did the idioms of distress scale with deletion of one item (Cronbach’s alpha=.80). Both scales were externally valid, yielding large correlations with depression, anxiety, and somatic complaints (rs between .54 to .80, ps < .05). Discussion: This is the first study to develop a comprehensive measure of trauma exposure with universal and culturally relevant reactions in India. This study also enhances HTQ usage in India by delineating all the steps in the adaptation process. Results can inform the development of trauma-focused interventions for Indian women from slums.

Women health: Psychological and most prominent somatic problems in 3-year follow-up in Bosnian refugees

Background: Little is known about gender differences among people exposed to war related trauma. Aim of this study is to explore gender differences in health status and comorbidity of mental and physical disorders in a cohort of Bosnian refugees followed up for 3 years (1996–1999). Methods: This longitudinal study included 534 subjects followed up for 3 years. The interviews were conducted in refugee camps in Varaždin, Croatia in Bosnian language. Data were collected using Harvard Trauma Questionnaire (Bosnian version) and Hopkins Checklist-25, respectively. Physical health disorders were self-reported. Results: In both assessments there was a statistically significant difference between men and women in the number of physical health disorders, even when results were controlled for educational status. Although there was no difference in total number of symptoms in both assessments ( F = 0.32; df = 1; p > 0.05 and F = 1.15; df = 1; p > 0.05), important physical health disorders were significantly more frequent among women than in men in different educational groups, namely high blood pressure and cardiovascular diseases, arthritis, and anaemia. Asthma, tuberculosis, cirrhosis of the liver, ulcer and epilepsy were more frequent in men than in women. There were no differences in frequencies of psychiatric disorders at baseline, but frequency of psychiatric disorders in women was higher at endpoint for uneducated respondents. There was significant difference compared to men in group of respondents without formal education, but only in comorbidity of PTSD and depression which was more often present in females (22.1%) than in males (3.6%). Conclusion: Our findings indicate the importance of gender and education on mental and physical health of people exposed to warrelated trauma. Long term health monitoring and programs, especially related to women’s health are needed in order to avoid lasting consequences.

Entwicklung einer Kultursensiblen Version des Mini-International Neuropsychiatric Interview (MINI) in hocharabischer Sprache

Zusammenfassung Ziel der Studie Trotz des erheblichen Bedarfs nach einer schnellen und effizienten Diagnostik aufgrund von aktuellen humanitären Krisen in der arabischen Welt, steht bisher keine validierte, hocharabische Version des Mini International Neuropsychiatric Interview (MINI) für die Versorgungsforschung zur Verfügung. Das Ziel der vorliegenden Pilotstudie war es daher, eine Übersetzung und kultursensible Adaptation des MINI ins Hocharabische zur Verfügung zu stellen sowie erste Validierungsversuche in einer arabischsprachigen Geflüchtetenstichprobe vorzunehmen.Methodik An dem mehrstufigen Adaptationsprozess waren mehrere psychiatrisch-psychotherapeutische ExpertInnen beteiligt, die sowohl mit der westlichen als auch der arabischen Kultur vertraut sind. N = 20 arabischsprachige geflüchtete PatientInnen nahmen an der Pilotstudie teil, die an der Clearingstelle der Charité, Universitätsmedizin Berlin rekrutiert werden konnten. Für die Feststellung der Kriteriumsvalidität wurden Diagnosen von ExpertInnen, die gegenüber den MINI Diagnosen ‚verblindet’ waren und Screeninginstrumente für Depression (Patient Health Questionnaire 9, PHQ-9) und die posttraumatische Belastungsstörung (PTBS) (Harvard Trauma Questionnaire, HTQ) herangezogen.Ergebnisse Aufgrund der ausführlichen Dokumentation kann der Prozess der kulturellen Adaptation detailliert nachvollzogen werden. Kappa Werte zeigten keine Übereinstimmung der MINI Diagnosen mit den ExpertInnendiagnosen, jedoch konnten hohe Übereinstimmungen zwischen den MINI Diagnosen und dem PHQ-9 (κ = .69) und dem HTQ (κ = .68) festgestellt werden. Schlussfolgerungen Die Ergebnisse der Pilotstudie werden als erste Hinweise für die Validität der hocharabischen Übersetzung des MINI gewertet und bilden die Grundlage für weitere, ausführliche Validierungsstudien. Darüber hinaus zeigt diese Studie einen Modellprozess für die kulturelle Adaptation psychometrischer Instrumente auf.

Influence of post-migration living difficulties on post-traumatic symptoms in Chinese asylum seekers resettled in Italy

Background: Little is known about mental health and resettlement difficulties of Chinese asylum seekers fleeing China due to religious persecutions. Aim: This study explores main post-migration living difficulties (PMLD) in this population, with a focus on their role in post-traumatic stress disorder (PTSD). Methods: A total of 67 patients (95.52% women, mean age 34.75 ± 7.63) were included in the study. The Harvard Trauma Questionnaire (HTQ) was used to assess PTSD, the List of Migration Experiences (LiMEs) was used for pre-migration and post-migration experiences (potentially traumatic events as well as living difficulties). The t-test was used to examine the differences in pre-migration and post-migration mean scores. Logistic regression was used to test the effect of pre-migration traumatic experiences (PMTE) and most frequent PMLD on having a PTSD. Results: A total of 49 patients scored above the HTQ cut-off score for PTSD. As expected, traumatic experiences were concentrated in the pre-migration phase, while living difficulties were present in both phases but more frequently in the post-migration period. PMTE were significantly related to PTSD (OR 1.29, p = .01). However, three PMLD (‘Feeling that you do not know where you will lend up tomorrow’, ‘Loneliness and boredom’ and ‘Not being able to find work’) showed a significant interaction with PMTE, suggesting that their presence in the post-migration phase has a modulation effect by increasing the likelihood of PTSD. Conclusion: This study extends to Chinese asylum seekers the previous evidence that PMLD have a significant role in the likelihood to have a PTSD after landing in the host country.

Prevalence of mental ill health, traumas and postmigration stress among refugees from Syria resettled in Sweden after 2011: a population-based survey

ObjectivesTo estimate the prevalence of and associations between anxiety, depression, post-traumatic stress disorder (PTSD), low subjective well-being (SWB), potential traumas and postmigration stress among refugees from Syria resettled in Sweden.DesignA cross-sectional and population-based questionnaire study based on a known and complete sample frame. The survey included multiple measures of mental ill health and factors of particular relevance for refugees. Weighted analyses were conducted to calculate representative prevalence rates and associations. Associations were investigated through a series of logistic regression analyses. All analyses were supplemented with robust 95% CIs.SettingSweden.ParticipantsA random sample of 1215 individuals (response rate 30.4%) from Syria aged 18–64 years that were granted residency in Sweden on grounds of asylum between 2011 and 2013.Main outcome measuresAnxiety, depression, PTSD and low SWB were assessed through Hopkins Symptom Checklist, Harvard Trauma Questionnaire and WHO-5 Well-being Index, using established cut-offs.ResultsA majority of the participants met the criteria for at least one of the studied types of mental ill health, and the comorbidity was high. Depression was the most the common type with 40.2% (95% CI 36.9% to 43.3%), followed by low SWB with 37.7% (95% CI 34.8% to 40.1%), anxiety with 31.8% (95% CI 29.2% to 34.7%) and PTSD with 29.9% (95% CI 27.2% to 32.6%). Refugee-related potentially traumatic events (PTEs) experienced before or during migration was common as was substantial levels of postmigration stress. Most types of refugee-related PTEs, especially being exposed to interpersonal violence, and postmigration stress were associated with increased risks for anxiety, depression, low SWB and PTSD.ConclusionsMental ill health, in terms of anxiety, depression, low SWB and PTSD, are highly elevated and comorbid among refugees from Syria. Increased attention from multiple societal sectors to adequately support Syrian refugees’ mental health needs, promoting recovery and reducing postmigration stress are needed.