No abstract

BackgroundRefugees and asylum-seekers are often exposed to multiple types of potentially traumatic events (PTEs) and report elevated rates of psychological disorders, including posttraumatic stress disorder (PTSD). Considering this, refugee populations merit continued research in the field of traumatic stress to better understand the psychological impact of these experiences. The symptom structure of PTSD underwent a major revision in the recent formulation in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and this reformulation has yet to be comprehensively investigated in the context of PTSD arising from traumatic events experienced by refugees. The current study assessed the construct validity of the DSM-5 PTSD structure in a refugee sample from a variety of cultural backgrounds alongside four alternate models commonly identified in western populations, namely the four-factor Dysphoria model, the five-factor Dysphoric Arousal model, and the six-factor Anhedonia and Externalising Behaviours models.MethodsA total of 246 refugees settled in Australia were assessed using the Harvard Trauma Questionnaire, to measure exposure to potentially traumatic events (PTEs), and the Posttraumatic Diagnostic Scale, to assess symptoms of PTSD based on DSM-5 criteria. All measures were translated into Arabic, Farsi or Tamil using rigorous translation procedures, or provided in English.ResultsFindings from five confirmatory factor analyses (CFAs) revealed that all models demonstrated acceptable model fit. However, an examination of relative fit revealed that the DSM-5 model provided the poorest fit overall for our sample. Instead, we found preliminary evidence in support of the six-factor Anhedonia model, comprising the symptom clusters of re-experiencing, avoidance, negative affect, anhedonia, dysphoric arousal and anxious arousal, as the superior model for our data.ConclusionsOur findings offer preliminary support for the applicability of the Anhedonia model to a culturally diverse refugee sample, and contribute to a growing body of studies which indicate that the DSM-5 model may not best represent the symptom structure of PTSD found across non-western conflict-affected populations.

Background: Emotion regulation difficulties are common among individuals from refugee backgrounds. Little is known, however, about whether there are specific patterns relating to the types of emotion regulation strategies commonly employed by refugees, nor how this relates to psychopathology. Moreover, wider literature on emotion regulation has primarily focused on examining specific emotion regulation strategies in isolation, rather than patterns of emotion regulation across multiple strategies. Objective: The current study was the first to identify individual differences in patterns of habitual emotion regulation among refugees, and explore their unique associations with trauma exposure and PTSD symptoms. Method: Levels of trait reappraisal and suppression were measured among 93 refugees, using the Emotion Regulation Questionnaire and the White Bear Suppression Inventory. A latent class analysis was conducted to identify distinct classes of participants based on differing levels of habitual engagement in reappraisal and suppression. The association between class membership and key variables indexing refugee experiences (e.g. trauma exposure) and psychopathology (e.g. PTSD symptoms and emotion dysregulation) were also examined. Results: Latent class analysis revealed three distinct profiles of habitual emotion regulation: a high regulators class (55.7%; high trait reappraisal/high trait suppression), an adaptive regulators class (23.6%; high trait reappraisal/moderate trait suppression), and a maladaptive regulators class (20.6%; low trait reappraisal/high trait suppression). Each class evidenced unique relations with trauma exposure and psychopathology. Compared to adaptive regulators, maladaptive regulators had more PTSD symptoms, experienced greater emotion dysregulation, and were more likely to be female, while high regulators had experienced more types of traumatic events. Conclusions: This study identified distinct patterns of emotion regulation among refugees. Our findings demonstrate the importance of measuring multiple strategies to uncover patterns of emotion regulation and better understand the links between emotion regulation and psychopathology, which has important implications for the development of effective treatment with traumatized refugees.

This study investigated whether the associations between emotion regulation and cognitive appraisals and symptoms of posttraumatic stress disorder (PTSD) differ between Asian American and European American trauma survivors. Asian American (n = 103) and European American (n = 104) trauma survivors were recruited through mTurk and completed an on-line questionnaire assessing cognitive appraisals, emotion regulation and PTSD symptomatology. The European American group reported greater trauma-specific rumination, psychological inflexibility, seeking out others for comfort, and negative self-appraisals than the Asian American group. The Asian American group reported greater secondary control appraisals and cultural beliefs about adversity than the European American group. Second, cultural group moderated the associations between (a) brooding rumination, (b) fatalism, (c) self-blame, and (d) negative communal self-appraisals and PTSD symptoms. These associations were larger for the European American group than the Asian American group. Third, there was an indirect pathway from self-construal (independent and interdependent) to PTSD symptoms through certain emotion regulation approaches and cognitive appraisals. Additionally, cultural group was found to moderate several of these indirect effects. These findings highlight the importance of considering cultural background and cultural values in understanding the processes involved in PTSD. Further research in this area is needed.

Objective: Emotion regulation (ER) may be an important psychological mechanism underpinning the development, and management, of posttraumatic stress disorder (PTSD) in refugees. Despite this, little is known about the ER strategies that refugees spontaneously deploy under stress, nor how effective different approaches may be at reducing distress. This was the first study to identify individual differences in patterns of spontaneous ER among refugees and explore their unique associations with negative affect and PTSD. Method: Spontaneous reappraisal and suppression use was measured among 82 refugees following a 5-min exposure to trauma-salient images. Negative affect was indexed before and after the exposure task. Latent profile analysis (LPA) was conducted to identify distinct profiles of participants based on differing levels of ER use. Results: LPA revealed two distinct profiles: a high ER variability profile (37%; high suppression/moderate-high reappraisal) and a low ER variability profile (63%; low suppression/moderate reappraisal). The low ER variability profile was associated with increased negative affect during the experimental paradigm, greater PTSD avoidance symptoms, and greater likelihood of insecure visa status compared with the high ER variability profile. Conclusions: Our findings suggest that a more variable ER approach in response to trauma-salient stressors results in lower distress and is associated with less severe PTSD symptoms. Better understanding the links between patterns of ER strategy use and psychopathology has important implications for the development of effective treatments for refugees. Clinical Impact StatementFindings suggest that refugees who spontaneously demonstrated greater emotion regulation (ER) variability (i.e., refugees who made greater use of both reappraisal and suppression strategies) in response to trauma-salient stressors were better able to downregulate their distress than those who adopted a less variable approach. Additionally, participants with greater spontaneous ER variability also exhibited fewer PTSD avoidance symptoms. Our findings provide preliminary support for the relevance of ER variability to the maintenance of PTSD. In particular, improving ER variability may be an important clinical target in psychological interventions for refugees with PTSD. However, replication of our findings is needed.