Complex post-traumatic stress disorder and post-migration living difficulties in traumatised refugees and asylum seekers: the role of language acquisition and barriers

Abstract

Background Numerous traumatic experiences and post-migration living difficulties (PMLDs) increase the risk of developing symptoms of complex post-traumatic stress disorder (CPTSD) among Afghan refugees and asylum seekers, living in Austria. Research has repeatedly associated higher levels of CPTSD with higher levels of PMLDs. Summarizing PMLDs into empirically derived factors might facilitate a further understanding of their interaction with symptom presentation within distinct clusters of CPTSD. Objective The current study aimed to investigate homogeneous subgroups of ICD-11 CPTSD and their association with demographic variables, traumatic experiences, and empirically derived factors of PMLDs. Method Within a randomized controlled trail (RCT) CPTSD, PMLDs, and traumatic experiences were assessed in a sample of 93 treatment-seeking Afghan refugees and asylum seekers through a fully structured face-to-face and interpreter-assisted interview using the ITQ, the PMLDC, and a trauma checklist. Underlying clusters of CPTSD, superior factors of PMLDs, and their associations were investigated. Results In total, 19.4% of the sample met the diagnostic criteria for PTSD and 49.5% for CPTSD. We identified a 2-cluster solution consisting of two distinct subgroups as best fitting: (1) a CPTSD cluster and (2) a PTSD cluster. The multitude of PMLDs was summarized into four superior factors. CPTSD cluster membership was associated with childhood potentially traumatic experience types, and one of four PMLD factors, namely ‘language acquisition & barriers’. Conclusions The results suggest that not PMLDs in general, but rather specific types of PMLDs, are associated with CPTSD. An assumed bidirectional relationship between these PMLD factors and CPTSD symptoms might lead to a downward spiral of increasing distress, and could be considered in treatment strategies.

Prevalence, comorbidities, and factors associated with prolonged grief disorder, posttraumatic stress disorder and complex posttraumatic stress disorder in refugees: A systematic review

“…More specifically, Frost (58) reported an experience of being an unarmed civilian during war/revolution/military coup and experiencing a serious accident as predictors of PTSD class membership. Accordingly, cPTSD was also associated with a higher number of traumatic events (58,59,70,71) and there was an association with childhood trauma: Younger age at first trauma predicted cPTSD symptoms in treatment-seeking refugees in Niger (60), membership in the cPTSD cluster was associated with a higher total number of childhood traumatic event types in treatment-seeking Afghan refugees (72), and more childhood adversities were found for refugees with cPTSD than for those with PTSDICD-11 in West Papuan refugees (59,70). Frost et al (58) found that physical assault, neglect, sexual assault, and serious accident were predictors of cPTSD class membership in a refugee subsample from a representative sample in the United States.…”

“…Frost et al (58) found that physical assault, neglect, sexual assault, and serious accident were predictors of cPTSD class membership in a refugee subsample from a representative sample in the United States. Three studies (60,61,64) found no association with the number of experienced traumas, and seven studies (62,63,(66)(67)(68)71,72) found no associations with trauma types, including being a victim of trafficking (63), adverse childhood experiences (68), and experience of torture above and beyond trauma load (67).…”

“…In a network analysis (72) those with cPTSD were more likely to live at a Humanitarian Site (60). Insecure visa status predicted PTSDICD-11 and cPTSD class membership in a study with refugees in Australia (71), and in Afghan refugees in Austria the cPTSD cluster was associated with more problems with language acquisition and barriers (72).…”

Context, coping, and mental health in refugees living in protracted displacement

“…For this study, a mean score of stressors was calculated, with higher scores representing stressors being a more serious problem. This scale has been widely used to measure ongoing stressors in refugees and has strong psychometric properties (e.g., Schiess‐Jokanovic et al 2021).…”

The boundaries between complex posttraumatic stress disorder symptom clusters and post-migration living difficulties in traumatised Afghan refugees: a network analysis

“…Deeper investigations of this relationship point out that while potentially traumatic experiences were related with posttraumatic stress disorder (PTSD), total distress due to PMLDs showed an relationship with disturbances of self-organisation (DSO) [ 20 ]. An analysis of the associations of various PMLD factors with CPTSD suggested that while language acquisition & barriers predicted the membership to the CPTSD subgroup, the other PMLD factors were equally present in both investigated subgroups [ 21 ]. These findings suggest individual boundaries between the symptom clusters of CPTSD and different forms of PMLDs.…”