The role of therapist support on effectiveness of an internet-based modular self-help intervention for adjustment disorder: a randomized controlled trial

Background: Adjustment disorder is among the most often diagnosed mental health disorders. Still, there is a lack of specific interventions available for adjustment disorder.

Objectives: The aim of this study was to test if an internet-based self-help intervention for adjustment disorder could be effective without therapist involvement.

Design: A parallel group randomized controlled trial design was used to test the effectiveness of the Brief Adjustment Disorder Intervention (BADI) – an internet-based intervention for adjustment disorder.

Methods: In total 1077 participants were randomized into two conditions: BADI intervention and BADI intervention with therapist support. The main outcome measures were symptoms of adjustment disorder and well-being.

Results: Pre-intervention to post-intervention adjustment disorder effect size for the BADI intervention group was d?=?0.64, and for the BADI with therapist support group the effect size was d?=?0.53.

Conclusions: The present study supported the effectiveness of the BADI intervention. Our findings also indicated that adding therapist support to the standard BADI intervention did not significantly improve the outcomes.     

Understanding associations between negatively biased attention and depression and social anxiety: positively biased attention is key

ABSTRACT

Background and objectives: Although research supports the premise that depressed and socially anxious individuals direct attention preferentially toward negative emotional cues, little is known about how attention to positive emotional cues might modulate this negative attention bias risk process. The purpose of this study was to determine if associations between attention biases to sad and angry faces and depression and social anxiety symptoms, respectively, would be strongest in individuals who also show biased attention away from happy faces.

Methods: Young adults (N?=?151; 79% female; M?=?19.63 years) completed self-report measures of depression and social anxiety symptoms and a dot probe task to assess attention biases to happy, sad, and angry facial expressions.

Results: Attention bias to happy faces moderated associations between attention to negatively valenced faces and psychopathology symptoms. However, attention bias toward sad faces was positively and significantly related to depression symptoms only for individuals who also selectively attended toward happy faces. Similarly, attention bias toward angry faces was positively and significantly associated with social anxiety symptoms only for individuals who also selectively attended toward happy faces.

Conclusions: These findings suggest that individuals with high levels of depression or social anxiety symptoms attend preferentially to emotional stimuli across valences.     

Randomized Controlled Trial of an Internet-Based Cognitive-Behavioral Treatment Program for Binge-Eating Disorder

Binge-eating disorder (BED) is a prevalent health condition associated with obesity. Few people with BED receive appropriate treatment. Personal barriers include shame, fear of stigma, geographic distance to mental health services, and long wait-lists. The aims of this study were to examine the efficacy of an Internet-based cognitive-behavioral intervention for adults with threshold BED (DSM-IV) and to examine the stability of treatment effects over 12 months. Participants were randomly assigned to a 16-week Internet-based cognitive-behavioral intervention (n = 69) or a wait-list condition (n = 70). Binge-eating frequency and eating disorder psychopathology were measured with the Eating Disorder Examination–Questionnaire and the Eating Disorder Examination administered over the telephone. Additionally, body weight and body mass index, depression, and anxiety were assessed before and immediately after treatment. Three-, 6-, and 12-month follow-up data were recorded in the treatment group. Immediately after the treatment the number of binge-eating episodes showed significant improvement (d = 1.02, between group) in the treatment group relative to the wait-list condition. The treatment group had also significantly reduced symptoms of all eating psychopathology outcomes relative to the wait-list condition (0.82 ≤ d ≤ 1.11). In the treatment group significant improvement was still observed for all measures 1 year after the intervention relative to pretreatment levels. The Internet-based intervention proved to be efficacious, significantly reducing the number of binge-eating episodes and eating disorder pathology long term. Low-threshold e-health interventions should be further evaluated to improve treatment access for patients suffering from BED.     

Long-Term Effects of an Internet-Based Treatment for Posttraumatic Stress

Abstract

Advances in communication technology offer additional strategies for providing psychological treatment. Previous trials of Internet-based treatment approaches reported significant reductions in posttraumatic stress and related symptoms in response to Internet-based treatments relative to control groups. However, empirical data on the long-term effects of those approaches are sparse. In order to evaluate the long-term effect of an Internet-based intervention, the authors conducted an 18-month follow-up of an Internet-based cognitive behavioural therapy for posttraumatic stress. Severity of posttraumatic stress symptoms was the primary outcome. Additional measures were depression, anxiety, mental and physical health, and health care utilization during the follow-up period. Treatment group participants (n = 34) were assessed 1.5 years after completing treatment. Results indicated that reductions in symptoms of posttraumatic stress symptoms, depression, and anxiety found at posttreatment were sustained during the 18-month follow-up period. Preliminary evidence on long-term effects of Internet-based health care as shown in this study is promising. However, research with larger and clinically more diverse samples is needed to fully assess the clinical impact and potential of Internet-based health care provision.     

Burnout during a long-term rehabilitation: comparing low burnout,high burnout – benefited,and high burnout – not benefited trajectories

Abstract

To focus rehabilitation activities among burnout clients more effectively, it is important to investigate who benefits from burnout interventions. This study (N=85) aimed at identifying burnout trajectories in terms of benefit, that is, subgroups of clients who share similar mean levels and changes in burnout during a one-year rehabilitation intervention (17 days in total) with a six-month follow-up. After identifying the burnout trajectories, the relations of the trajectories with factors describing the clients, antecedents, and consequences of burnout during the one-year intervention were examined. Three burnout trajectories were identified by growth mixture modeling: (a) low burnout (n=39), (b) high burnout – benefited (n=29), and (c) high burnout – not benefited (n=17). Positive changes were detected in antecedents and consequences among the clients in the low burnout and high burnout – benefited trajectories. Recovery from burnout was associated with increased job resources and decreased job demands, as well as with increased job satisfaction and decreased depression. It seems that more precise targeting of rehabilitation is needed since the trajectories revealed not only clients with mild symptoms, but also clients who probably received this treatment too late.     

Efficacy of Telehealth Treatments for Posttraumatic Stress-Related Symptoms: A Meta-Analysis

This meta-analysis summarizes the findings of outcome research on the degree to which telehealth treatments reduce posttraumatic stress disorder (PTSD)-related symptoms. In a search of the literature, 13 studies were identified for inclusion in the meta-analysis and were coded for relevant variables. A total of 725 participants were included. Results indicate that telehealth treatments are associated with significant pre- to postreduction in PTSD symptoms (d = 0.99, 95% confidence interval [CI]: 0.87–1.11, p < .001), and result in superior treatment effects relative to a wait-list comparison condition (d = 1.01, 95% CI: 0.76–1.26, p < .001). However, no significant findings were obtained for telehealth intervention relative to a supportive counseling telehealth comparison condition (d = 0.11, 95% CI: ? 0.38 to 0.60, p = .67), and telehealth intervention produced an inferior outcome relative to a face-to-face intervention (d = ? 0.68, 95% CI: ? 0.39 to ? 0.98, p < .001). Findings for depression symptom severity outcome were generally consistent with those for PTSD outcome. Telehealth interventions produced a significant within-group effect size (d = 0.98, 95% CI: 0.86 to 1.10, p < .001) and superior effect relative to wait-list comparison condition (d = 0.80, 95% CI: 0.56–1.05, p < .001). Relative to face-to-face interventions, telehealth treatments produced comparable depression outcome effects (d = 0.13, 95% CI: ? 0.55 to 0.28, p = .53). Taken together, these findings support the use of telehealth treatments for individuals with PTSD-related symptoms.     

Effects of guided imagery with relaxation training on anxiety and quality of life among patients with inflammatory bowel disease

Background: Inflammatory Bowel Disease (IBD) impacts quality of life (QoL). Psychological factors influence the course of the disease and should be targeted for intervention.

Methods: Our study was a prospective, randomised control trial. Fifty-six outpatients were randomly chosen and allocated to a treatment group or a waiting-list control group. Treatment group patients attended three relaxation-training sessions and received an audio disc for home practice. Evaluations performed pre and post-treatment: state anxiety was assessed with the State-Trait Anxiety Inventory, QoL with the IBD Questionnaire. The Visual Analogue Scale assessed pain, depression, stress and mood. Patients completed a symptom monitoring diary. The control group's symptoms were monitored without study-related treatment.

Results: Thirty-nine subjects completed the study and were included in the data analysis. Following the relaxation-training intervention, the treatment group's (n?=?18) measured results showed a statistically significant improvement as compared to the control group (n?=?21) (time by treatment interaction): anxiety levels decreased (p?<?0.01), QoL and mood improved (p?<?0.05), while levels of pain and stress decreased (p?<?0.01).

Conclusions: Findings indicate IBD patients may benefit from relaxation training in their holistic care. New studies as well as further investigation of the subject are warranted.     

Internet-based acceptance and commitment therapy for psychological distress experienced by people with hearing problems: a pilot randomized controlled trial

Psychological distress is common among people with hearing problems, but treatments that specifically target this aspect have been almost non-existent. In this pilot randomized controlled trial, an eight-week long Internet-based treatment, informed by Acceptance and Commitment Therapy, was administered to explore the feasibility and efficacy of such a treatment. Included participants were randomized to either treatment (n = 31) or wait-list control (n = 30) condition. All participants were measured prior to randomization and immediately after treatment ended using standardized self-report instruments measuring hearing-related emotional and social adjustment (Hearing Handicap Inventory for the Elderly – S, HHIE-S), quality of life (Quality of Life Inventory, QOLI), and symptoms of depression and anxiety (Patient health Questionnaire, PHQ-9 and Generalized Anxiety Disorder scale, GAD-7). Linear mixed effects regression analysis using the full intention-to-treat sample demonstrated that the treatment had superior outcomes on the main outcome measure as compared with the control group, Cohen’s d = 0.93, 95% CI [0.24, 1.63]. The benefits of treatment over control were also evident in scores of depression, Cohen’s d = 0.61, 95% CI [0.04, 1.19], and quality of life, Cohen’s d = 0.88, 95% CI [0.14, 1.61]. The results provide preliminary support for Internet-delivered acceptance and commitment therapy as a potentially effective treatment of psychological symptoms associated with hearing problems.     

The impact of valence framing on response expectancies of side effects and subsequent experiences: a randomised controlled trial

Abstract

Objective: Pre-treatment side effect expectancies often influence subsequent experiences; however, expectancy-based reduction strategies are lacking. We explored whether framing information about adverse responses (in positive or negative formats) altered expectancies and experiences of a cold pressor task. We further investigated associations between expectancies and experiences, to inform potential interventions.

Design: Healthy volunteers (N?=?134), randomised to receive positively- or negatively-framed pre-cold pressor task information, self-rated 12 expectancies for cold pressor experiences, emotional state and coping style.

Main Outcome Measures: Self-reports of the same 12-experiences (recorded during and after the experiment) were assessed.

Results: Framing had minimal impact on expectancies and experiences; however, discomfort threshold (p?=?.08, d?=?0.22) showed a trend in the expected direction. Hierarchical regressions revealed expectancies uniquely, significantly predicted 6–23% of the variance for 11 subsequent experiences. Following a popular charity event (Ice Bucket Challenge), all participants showed higher ‘discomfort thresholds’ (p?=?.001, d?=?0.59), and those in the negative frame reported more overall ‘discomfort’ (p?=?.01, d?=?0.60) than participants in the positive condition.

Conclusion: Expectancies uniquely influenced subsequent cold pressor experiences. Framing had minimal impact in this ‘analogue’ medical setting, only influencing ‘discomfort threshold’. ‘Discomfort threshold’ and overall ‘discomfort’ were also impacted by a social media challenge, highlighting a potential area for intervention.     

The role of goal adjustment in symptoms of depression,anxiety and fatigue in cancer patients receiving psychosocial care: A longitudinal study

Objective: This study examined whether cancer patients reported increases in their goal adjustment capacities while receiving psychosocial care and whether these increases were related to changes in symptoms of depression, anxiety and fatigue. Goal adjustment was conceptualised as two independent capacities: goal disengagement (i.e. disengage from unattainable goals) and goal reengagement (i.e. reengage into new goals).

Design: This naturalistic, longitudinal study focused on 241 cancer patients receiving psychosocial care at one of the seven psycho-oncology institutions in the Netherlands. Data was collected before the start of psychosocial care (T1) and nine months thereafter (T2). Hierarchical regression analysis was used to examine the research questions.

Main Outcome Measures: Goal adjustment, symptoms of depression, anxiety and fatigue.

Results: At group level, patients reported small increases in goal disengagement (d = .22) but no significant change in goal reengagement (d = .09). At an individual level, 34% of cancer patients reported an increase in goal disengagement and 30% reported an increase in goal reengagement. Increases in goal reengagement were significantly associated with decreases in both depressive and anxiety symptoms, but not to changes in fatigue.

Conclusion: Findings indicate that particularly improvements in goal reengagement are beneficial for cancer patients’ psychological functioning.     

The association between attention control,anxiety, and depression: the indirect effects of repetitive negative thinking and mood recovery

Background and objectives: Attention control deficits and repetitive negative thinking (RNT; i.e., rumination) may be key factors in the development and persistence of depression and anxiety, although their role in symptom development remains poorly understood. This represents a gap in the literature, as interventions targeting attention control and associated RNT may enhance interventions and prevent costly relapse. The current study was designed to examine the serial indirect effects of transdiagnostic RNT and negative affect recovery following a lab-induced stressor on the association between attention control deficits and trait anxiety and depression.

Methods: Participants were N?=?583 university students who completed validated measures of RNT, anxiety, depression, and mood ratings pre- and post-stressor. Stress was induced using a modified version of the Trier Social Stress Test.

Results: Results of cross-sectional indirect effects models indicated that RNT and mood recovery explained the association between attention control deficits and trait anxiety and depression. Results from reversed models indicated that only the indirect effect of RNT was significant.

Conclusions: Findings suggest that RNT and mood recovery processes play an important role in explaining anxiety and depression symptoms. Additional work is needed to examine their role in symptom development and maintenance over time.     

Insomnia symptoms are associated with elevated C-reactive protein in young adults

Abstract

Objective: Insomnia is associated with elevated inflammation; however, studies have not investigated if this relationship is confounded with depression and neuroticism, which are associated with insomnia and inflammation. The current study examined the association of insomnia symptoms with C-reactive protein (CRP) and with interleukin-6 (IL-6), independently and after controlling for depressive symptoms and neuroticism. Design: Fifty-two young adults (mean age?=?25.2?±?3.9 years, 52% female) completed a baseline survey to assess psychological characteristics, followed by a plasma blood draw. Main outcome measures: Plasma CRP and IL-6. Results: When examined alone, insomnia symptoms were significantly associated with elevated CRP (β?=?0.52; R²?=?0.27), as was neuroticism (β?=?0.41, R²?=?0.17), but not depressive symptoms (β?=?0.21, R²?=?0.05). The association between insomnia symptoms and CRP remained significant when depressive symptoms and neuroticism were entered into the model simultaneously; this model did not explain more variance than the model with insomnia symptoms alone. No variables were associated with IL-6. Conclusions: Results suggest that insomnia symptoms are independently associated with elevated CRP in young adults, even after controlling for presumed overlapping psychological constructs. Findings highlight the potential importance of treating insomnia to reduce systemic inflammation.     

Depressive symptoms in outpatients with heart failure: Importance of inflammatory biomarkers,disease severity and personality

Objective: Depressive symptoms are highly prevalent in heart failure (HF) patients, however the underlying etiology of depression in HF patients remains yet unclear. Hence, the goal is to examine the relative importance of inflammation, disease severity and personality as predictors of depression in HF patients. Design: Depressive symptoms (Hospital Anxiety and Depression Scale, depression subscale) were assessed at baseline and one-year follow-up in 268 HF patients (75.6% men; mean age?=?66.7?±?8.7). Markers of inflammation (TNFα, sTNFr1, sTNFr2, IL-6 and IL-10), disease severity (e.g. New York Heart Association (NYHA) classification) and personality (Type D personality, loneliness) were assessed at baseline. Results: At baseline, NYHA class, body mass index, educational level, Type D personality and loneliness were significantly associated with depression. Higher NYHA class (B?=?2.25; SE?=?.83), higher educational level (B?=?1.41; SE?=?.48), Type D personality (B?=?2.56; SE?=?.60) and loneliness (B?=?.19; SE?=?.05) were also independently associated with higher depression levels at one-year follow-up (all p-values?<?.005). Inflammation, brain natriuretic peptide and left ventricular ejection fraction were not related to depression over time. Conclusions: Personality factors, but not inflammation, were independent concomitants of depressive symptoms in patients with HF. Gaining more insight into the etiology of depression in HF patients is important in order to identify potential targets for novel interventions.     

Effects of a prevention program for divorced families on youth cortisol reactivity 15 years later

Objective: We examined whether an empirically based, randomised controlled trial of a preventive intervention for divorced mothers and children had a long-term impact on offspring cortisol regulation.

Design: Divorced mothers and children (age 9–12) were randomly assigned to a literature control condition or the 11-week New Beginnings Program, a family-focused group preventive intervention for mothers and children in newly divorced families.

Main Outcome Measures: Fifteen years after the trial, offspring salivary cortisol (n = 161) was measured before and after a social stress task.

Results: Multilevel mixed models were used to predict cortisol from internalizing symptoms, externalizing symptoms, group assignment and potential moderators of intervention effects. Across the sample, higher externalizing symptoms were associated with lower cortisol reactivity. There was a significant group-by-age interaction such that older offspring in the control group had higher reactivity relative to the intervention group, and younger offspring in the control group exhibited a decline across the task relative to younger offspring in the intervention group.

Conclusions: Preventive interventions for youth from divorced families may have a long-term impact on cortisol reactivity to stress. Results highlight the importance of examining moderators of program effects.     

Internet-delivered cognitive behavior therapy for anxiety and insomnia in a higher education context

Background and Objectives: Anxiety and insomnia can be treated with internet-delivered Cognitive Behavioral Therapy (iCBT). iCBT may be well-suited to students who are known to be poor help-seekers and suffer these symptoms. iCBT can offer easy access to treatment and increase service availability. The aim of this study was to evaluate the efficacy of anxiety and insomnia iCBT programs in students. Design: A randomized, controlled study. Methods: Students were randomly allocated to intervention (“Anxiety Relief”: n?=?43; “Insomnia Relief”: n?=?48; control: n?=?47). Interventions lasted six weeks. Outcome measures were the State-Trait Anxiety Inventory and the Pittsburgh Sleep Quality Index. Results: Significant within-group reductions in anxiety (t(31)?=?2.00, p?=?.03) with moderate between-groups (compared to control) effect size (d?=?.64) and increases in sleep quality (t(31)?=?3.46, p?=?.002) with a moderate between-groups effect size (d?=?.55) were found for completers of the anxiety program from pre- to post-intervention. Significant within-group increases in sleep quality were found for completers of the insomnia program from pre- to post-intervention (t(35)?=?4.28, p?>?.001) with a moderate between-groups effect size (d?=?.51). Conclusions: Findings support the use of iCBT for anxiety and insomnia in students, and indicate that further research is needed.     

Standardized Web-Based Cognitive Behavioural Therapy of Mild to Moderate Depression: A Randomized Controlled Trial with a Long-Term Follow-Up

Depression is common but undertreated. Web-based self-help provides a widely accessible treatment alternative for mild to moderate depression. However, the lack of therapist guidance may limit its efficacy. The authors assess the efficacy of therapist-guided web-based cognitive behavioural treatment (web-CBT) of mild to moderate depression. Fifty-four individuals with chronic, moderate depression participated in a randomized wait-list controlled trial, with an 18-month follow-up (immediate treatment: n = 36, wait-list control: n = 18). Primary outcome measures were the Beck Depression Inventory (BDI-IA) and the Depression scale of the Symptom Checklist-90-Revised (SCL-90-R. DEP). Secondary outcome measures were the Depression Anxiety Stress Scales and the Well-Being Questionnaire. Five participants (9%) dropped out. Intention-to-treat analyses of covariance revealed that participants in the treatment condition improved significantly more than those in the wait-list control condition (.011 < p < .015). With regard to the primary measures, between-group effects (d) were 0.7 for the BDI-IA and 1.1 for the SCL-90-R DEP. Posttest SCL-90- R DEP scores indicated recovery of 49% of the participants in the treatment group compared with 6% in the control group (odds ratio = 14.5; p < .004). On average, the effects were stable up to 18 months (n = 39), although medication was a strong predictor of relapse. The results demonstrate the efficacy of web-CBT for mild to moderate depression and the importance of therapist guidance in psychological interventions.     

Associations between job burnout and self-efficacy: a meta-analysis

Background and Objectives: This study aimed at systematically reviewing and meta-analyzing the strength of associations between self-efficacy and job burnout (the global index and its components). We investigated whether these associations would be moderated by: (a) the type of measurement of burnout and self-efficacy, (b) the type of occupation, (c) the number of years of work experience and age, and (d) culture. Design and Methods: We systematically reviewed and analyzed 57 original studies (N?=?22,773) conducted among teachers (k?=?29), health-care providers (k?=?17), and other professionals (k?=?11). Results: The average effect size estimate for the association between self-efficacy and burnout was of medium size (?.33). Regarding the three burnout components, the largest estimate of the average effect (?.49) was found for the lack of accomplishment. The estimates of the average effect were similar, regardless of the type of measures of burnout and self-efficacy measurement (general vs. context-specific). Significantly larger estimates of the average effects were found among teachers (compared to health-care providers), older workers, and those with longer work experience. Conclusions: Significant self-efficacy–burnout relationships were observed across countries, although the strength of associations varied across burnout components, participants' profession, and their age.     

Experiences with stigmatization among transgender individuals after transition: A qualitative study in the Netherlands

Abstract

Background: Transgender individuals belong to one of the most stigmatized groups in society. Although the social stigma of transgender individuals has been examined many times, post transition stigma experiences among transgender individuals have received limited research attention. The aim of this study was to examine experiences with stigmatization among Dutch transgender individuals after their transition.

Method: Ten trans women (age: M?=?58.50, SD?=?9.49) and 10 trans men (age: M?=?42.90, SD?=?13.62) participated in face-to-face semistructured interviews. Grounded theory was used to conceptualize and analyze the data. We examined the positive and negative reactions that transgender individuals experienced in the period after their transition. Furthermore, we explored differences between experiences of trans men and trans women. Finally, we examined differences between cisgender men and women regarding their reactions toward transgender individuals.

Results: Participants reported improved psychological well-being since transition. However, they still experienced different forms of stigmatization. Trans women appeared to experience stronger social stigma than trans men. Trans women also experienced lower social status after their transition. They mainly experienced negative responses from cisgender men. Participants emphasized the importance of social and peer support.

Conclusion: The current study findings demonstrate the presence of stigmatization after transition and argue for psychological aftercare. Social and peer support appeared to be important for coping with stigmatization, and improving the social network of transgender individuals is beneficial. Health providers and researchers are recommended to promote the development of constructive coping skills for transgender individuals with interventions especially targeting trans women.     

Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms

Background: Many women experience childbirth as traumatic and 2% develop post-traumatic stress disorder. This study examined the role of health practitioner support and personal control during birth as predictors of post-traumatic stress (PTS) symptoms, adjusting for vulnerability factors of prior trauma, depression, control beliefs and birth intervention. It also investigated interactions between support, prior trauma and birth intervention and their association with PTS symptoms.

Methods: A prospective longitudinal survey of 138 women recruited from UK NHS maternity clinics. Measures were taken in pregnancy, 3 weeks and 3 months after the birth.

Results: Support and control during birth were not predictive of postnatal PTS symptoms. However, support was predictive of PTS symptoms in a subset of women with prior trauma (β?=??0.41, R ²?=?16%) at both 3-weeks and 3-months postpartum. The interaction of birth intervention and support was associated with PTS symptoms 3 months after birth, the relationship between support and PTS symptoms was stronger in women experiencing more intervention.

Conclusions: Low support from health practitioners is predictive of postnatal PTS symptoms in women who have a history of trauma. Longer term effects of low support on postnatal PTS symptoms are also found in women who had more intervention during birth.     

Stigma modifies the association between social support and mental health among sexual violence survivors in the Democratic Republic of Congo: implications for practice

Background and Objectives: The aim of this study was to further understanding of the relationship between social support, internalized and perceived stigma, and mental health among women who experienced sexual violence in the eastern Democratic Republic of Congo (DRC).

Methods: Drawing from baseline survey data collected in eastern DRC, researchers conducted a secondary cross-sectional analysis using data from 744 participants. Regression and moderation analyses were conducted to examine associations between social support variables, felt stigma, and depression, anxiety and posttraumatic stress disorder (PTSD).

Results: Emotional support seeking and felt stigma were positively associated with increased symptom severity across all three mental health variables. Stigma modified associations between emotional support seeking and depression (t?=??2.49, p?=?.013), anxiety (t?=??3.08, p?=?.002), and PTSD (t?=??2.94, p?=?.003). Increased frequency of emotional support seeking was associated with higher mental health symptoms of anxiety and PTSD among women experiencing all levels of stigma.

Conclusions: Enhancing understanding of social support and stigma may inform research and intervention among Congolese forced migrant populations across circumstances and geographic locations. Implications for practice and research are discussed.