Mental health problems and post-migration stress among multi-traumatized refugees attending outpatient clinics upon resettlement to Norway

Refugees have often been exposed to multiple traumas making them prone to mental health problems later. The aim of this study is to describe the prevalence and symptom load of psychiatric disorders in refugees admitted to psychiatric outpatient clinics and to investigate the relationship between multiple exposure to traumatic events, the severity of traumatic symptoms and post-migration stressors. A clinical sample of 61 refugee outpatients from psychiatric clinics in Southern Norway was cross-sectionally examined using three structured clinical interviews (SCID-PTSD, SIDES and MINI) and self-report psychometric instruments (HSCL-25, IES-R). Post-traumatic Stress Disorder (PTSD) was diagnosed in 82% of the patients, while Disorders of Extreme Stress Not Otherwise Specified (DESNOS) was present in 16% of them. Comorbidity was considerable; 64% of the patients had both PTSD and major depression disorder (MDD) and 80% of those who had PTSD had three or more additional diagnoses. Multi-traumatized refugees in outpatient clinics have high prevalence of PTSD, DESNOS, comorbid depression and anxiety disorders. A more severe symptomatology was found in patients diagnosed with both PTSD and DESNOS, than in those diagnosed with only PTSD. Higher rates of unemployment, weak social network and weak social integration were also prevalent in these outpatients, and related to increased psychiatric comorbidity and severity of symptoms. Further research may clarify the existence of a cumulative relationship between pre-resettlement traumas and post-resettlement stressors in the mental health of refugees, which in turn may help to improve therapeutic interventions.     

Destructiveness, atrocities and healing: epistemological and clinical reflections

In this paper, destructiveness is approached as a multi-dimensional phenomenon where the mental health perspective addresses only one of these dimensions. An attempt is made to locate this phenomenon in the context of epistemological and societal considerations. Critical of mono-dimensional explanations based on causal-reductive epistemology, the paper instead proposes the idea of an 'ecology of destructiveness', according to which mental health professionals cannot possibly continue to assume the role of detached observers. The ordinariness and archetypal fascination of destructiveness are discussed as preventing the psychologizing and pathologizing of it. In addition, it is suggested that 'destructiveness may be a tragic facet of the human condition', without this implying any justification of it. Based on my work with a group of Bosnian ex-camp prisoners, some basic principles of how one can work with survivors of atrocities are derived and discussed. A central feature of this work is the attempt to create an appropriate therapeutic context within which a 'therapeutic presence' and 'therapeutic witnessing' can be developed. Finally, the relevance of Jungian insights to this kind of work is reviewed and the emergence of new types of defences of the self is identified.     

Why Does Disaster Recovery Work Influence Mental Health?: Pathways through Physical Health and Household Income

Disaster recovery work increases risk for mental health problems, yet the mechanisms underlying this association are unclear. We explored links from recovery work to post‐traumatic stress (PTS), major depression (MD), and generalized anxiety disorder (GAD) symptoms through physical health symptoms and household income in the aftermath of the Deepwater Horizon oil spill. As part of the NIEHS GuLF STUDY, participants (N = 10,141) reported on cleanup work activities, spill‐related physical health symptoms, and household income at baseline, and mental health symptoms an average of 14.69 weeks (SD = 16.79) thereafter. Cleanup work participation was associated with higher physical health symptoms, which in turn were associated with higher PTS, MD, and GAD symptoms. Similar pattern of results were found in models including workers only and investigating the influence of longer work duration and higher work‐related oil exposure on mental health symptoms. In addition, longer worker duration and higher work‐related oil exposure were associated with higher household income, which in turn was associated with lower MD and GAD symptoms. These findings suggest that physical health symptoms contribute to workers’ risk for mental health symptoms, while higher household income, potentially from more extensive work, might mitigate risk.     

The Multilevel Relationships of HIV‐Related Stigma to Child and Caregiver Mental Health among HIV‐Affected Households in South Africa

HIV/AIDS‐related (HAR) stigma is still a prevalent problem in Sub‐Saharan Africa, and has been found to be related to mental health of HIV‐positive individuals. However, no studies in the Sub‐Saharan African context have yet examined the relationship between HAR stigma and mental health among HIV‐negative, HIV‐affected adults and families; nor have any studies in this context yet examined stigma as an ecological construct predicting mental health outcomes through supra‐individual (setting level) and individual levels of influence. Multilevel modeling was used to examine multilevel, ecological relationships between HAR stigma and mental health among child and caregiver pairs from a systematic, community‐representative sample of 508 HIV‐affected households nested within 24 communities in KwaZulu‐Natal, South Africa. Two distinct dimensions of HAR stigma were measured: individual stigmatizing attitudes, and perceptions of community normative stigma. Findings suggest that individual‐level HAR stigma significantly predicts individual mental health (depression and anxiety) among HIV‐affected adults; and that community‐level HAR stigma significantly predicts both individual‐level mental health outcomes (anxiety) among HIV‐affected adults, and mental health outcomes (PTSD and externalizing behavior scores) among HIV‐affected children. Differentiated patterns of relationships were found using the two different stigma measures. These findings of unique relationships identified when utilizing two conceptually distinct stigma measures, at two levels of analysis (individual and community) suggest that HAR stigma in this context should be conceptualized as a multilevel, multidimensional construct. These findings have important implications both for mental health interventions and for interventions to reduce HAR stigma in this context.     

The Problem of a Transcendent God for the Well‐Being of Continuous Creation

This year marks the 30th Anniversary of Lynn White's critique of Christianity, which set off the field of eco‐theology. At that time, apologetic theologians responded to the White critique, that the Genesis “dominion” command is largely responsible for the contemporary ecological crisis, through reformulating Christian doctrines to address ecological issues. These pioneers have brought us a long way in terms of addressing both how Christianity has been responsible in supporting harmful human‐earth relations and what resources within the tradition might be useful for addressing the contemporary ecological crisis. Building on this work, this article suggests that Christian theology (whether eco or not) will continue to support an understanding of the human being as rooted “outside of creation” as long as the concept of a transcendent, Omni, Creator‐God is left intact. In place of this theological discourse of transcendence which secularizes the natural realm, I suggest a “radical materialist” (Val Plumwood) understanding of Christianity that moves between idealism and reductive materialism (both are forms of transcendence) through a “planetary” (Spivak) understanding of Creation and a “bio‐historical” (Gordon Kaufman) understanding of anthropology.     

Interoceptive Exposure Therapy Combined with Trauma‐related Exposure Therapy for Post‐traumatic Stress Disorder: a Case Report

Trauma‐related exposure therapy is a useful but not universally effective treatment for post‐traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post‐traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma‐related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician‐Administered Post‐traumatic Stress Disorder Scale, a self‐report measure of post‐traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post‐traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1‐ and 3‐month follow‐up. Symptoms of anxiety sensitivity and post‐traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post‐traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma‐related exposure therapy as a means of boosting treatment efficacy.     

The impact of cognitive behavioral therapy on post event processing among those with social anxiety disorder

Individuals with social anxiety are prone to engage in post event processing (PEP), a post mortem review of a social interaction that focuses on negative elements. The extent that PEP is impacted by cognitive behavioral therapy (CBT) and the relation between PEP and change during treatment has yet to be evaluated in a controlled study. The current study used multilevel modeling to determine if PEP decreased as a result of treatment and if PEP limits treatment response for two types of cognitive behavioral treatments, a group-based cognitive behavioral intervention and individually based virtual reality exposure. These hypotheses were evaluated using 91 participants diagnosed with social anxiety disorder. The findings suggested that PEP decreased as a result of treatment, and that social anxiety symptoms for individuals reporting greater levels of PEP improved at a slower rate than those with lower levels of PEP. Further research is needed to understand why PEP attenuates response to treatment.     

Contextualizing rape: Reviewing sequelae and proposing a culturally inclusive ecological model of sexual assault recovery

Consistent evidence demonstrates that many women who encounter the trauma of rape experience a range of both acute reactions and chronic psychological sequelae. This article reviews both the short- and long-term psychological adjustment issues associated with rape. In addition, we propose a culturally inclusive ecological model of sexual assault recovery (CIEMSAR), which integrates and extends existing models to better examine the complex factors leading to differential postrape adjustment. Important components of the CIEMSAR are placing rape in the broader sociocultural context of the United States and explicated socioracial and ethnic factors influencing the recovery process. The five primary factors of CIEMSAR are outlined, including (a) macrosystem or sociocultural context factors; microsystem/individual factors such as (b) assault characteristics, (c) person variables, (d) coping responses; and mesosystems factors such as (e) social-support systems. Suggestions for future research are also provided.     

“90后”大一新生适应性及心理健康状况研究

目的研究分析"90后"大一新生心理适应能力及心理健康状况,为更好地开展"90后"大一新生的心理健康教育工作提供依据。方法采用心理适应能力问卷和症状自评量表(SCL-90)对四川大学和四川师范大学2009级800名新生进行调查。结果①有54.9%的学生心理适应能力较差,仅有3.3%的学生有较强的心理适应能力;②"90后"大一新生的心理健康水平总体低于全国青年常模,除躯体化和敌对因子外,其它因子得分显著高于常模(P0.05);③不同心理适应能力的"90后"大一新生在SCL-90各个维度上均存在显著差异(P0.05),但性别比较时,只在恐怖因子上存在显著差异(P0.05)。结论"90后"大一新生心理健康状况不容忽视,学校应结合"90后"学生的特点,加强心理健康教育,提高"90后"大一新生的心理适应能力及心理健康水平。