Intermittent Explosive Disorder amongst Women in Conflict Affected Timor-Leste: Associations with Human Rights Trauma, Ongoing Violence, Poverty, and Injustice

Rees, Susan; Silove, Derrick; Verdial, Teresa; Tam, Natalino; Savio, Elisa; Fonseca, Zulmira; Thorpe, Rosamund; Liddell, Belinda J.; Zwi, Anthony B.; Tay, Kuowei; Brooks, Robert T.; Steel, Zachary

doi:10.1371/journal.pone.0069207

Cited by 57 publications

(94 citation statements)

References 35 publications

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“…However, evidence suggests that different aspects of affect dysregulation may be more salient in certain types of trauma. For example, symptoms that fall into the hyper-activation domain include uncontrollable anger, which has been found to have a relatively low endorsement in adult survivors of child sexual abuse (Cloitre, Garvert, Weiss, Carlson, & Bryant, 2014), whereas it has been found to be highly endorsed in survivors of mass conflict and severe human rights violations (Hinton, Hsia, Um, & Otto, 2003; Murphy, Elklit, Dokkedahl, & Shevlin, 2016; Rees et al, 2013). Moreover, in a study of survivors of an industrial disaster, anger was the only symptom that increased over a period of 30 months (Weisæth, 1984).…”

Section: Discussionmentioning

confidence: 99%

Testing competing factor models of the latent structure of post-traumatic stress disorder and complex post-traumatic stress disorder according to ICD-11

Murphy

Elklit

Dokkedahl

et al. 2018

European Journal of Psychotraumatology

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With the publication of the International Statistical Classification of Diseases and Related Health Problems, 11th edition (ICD-11) due for release in 2018, a number of studies have assessed the factorial validity of the proposed post-traumatic stress disorder (PTSD) and complex (CPTSD) diagnostic criteria and whether the disorders are correlated but distinct constructs. As the specific nature of CPTSD symptoms has yet to be firmly established, this study aimed to examine the dimension of affect dysregulation as two separate constructs representing hyper-activation and hypo-activation. Seven alternative models were estimated within a confirmatory factor analytic framework using the International Trauma Questionnaire (ITQ). Data were analysed from a young adult sample from northern Uganda (n = 314), of which 51% were female and aged 18–25 years. Forty per cent of the participants were former child soldiers (n = 124) while the remainder were civilians (n = 190). The prevalence of CPTSD was 20.8% and PTSD was 13.1%. The results indicated that all models that estimated affective dysregulation as distinct but correlated constructs (i.e. hyper-activation and hypo-activation) provided satisfactory model fit, with statistical superiority for a seven-factor first-order correlated model. Furthermore, individuals who met the criteria for CPTSD reported higher levels of war experiences, symptoms of anxiety and depression, and somatic problems than those with PTSD only and no diagnosis. There was also a much larger proportion of former child soldiers that met the criteria for a CPTSD diagnosis. In conclusion, these results partly support the factorial validity of the ICD-11 proposals for PTSD and CPTSD in a non-Western culture exposed to mass violence. These findings highlight that more research is required across different cultural backgrounds before firm conclusions can be made regarding the factor structure of CPTSD using the ITQ.

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Section: Discussionmentioning

confidence: 99%

Testing competing factor models of the latent structure of post-traumatic stress disorder and complex post-traumatic stress disorder according to ICD-11

Murphy

Elklit

Dokkedahl

et al. 2018

European Journal of Psychotraumatology

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“…Past studies in the field, including in Timor-Leste, have suggested that cumulative trauma 11 and ongoing adversity ( poverty and family/community conflict) are important factors in exacerbating symptoms of PTS and psychological distress, 10 but most past inquiries have been limited by their cross-sectional designs. [12][13][14] The unique aspect of our inquiry is its longitudinal design and the intercession of a recurrent period of conflict (2006)(2007) at the midpoint of follow-up, exposing our study population to further trauma. An additional factor which we explore is the influence of the sense of injustice on symptom trajectories, focusing on relevant historical periods in which the population was exposed to human rights abuses and severe deprivations.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…An additional factor which we explore is the influence of the sense of injustice on symptom trajectories, focusing on relevant historical periods in which the population was exposed to human rights abuses and severe deprivations. 14 The broad aim of this further analysis of our longitudinal study in Timor-Leste was to identify trajectories of PTSS and severe psychological distress over the 6-year follow-up period. We anticipated identifying the polar extremes reported in other studies in high-income countries, that is, a persisting high-symptom and low-symptom class, respectively.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Six-year trajectories of post-traumatic stress and severe psychological distress symptoms and associations with timing of trauma exposure, ongoing adversity and sense of injustice: a latent transition analysis of a community cohort in conflict-affected Timor-Leste

et al. 2016

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ObjectivesTo identify the 6-year trajectories of post-traumatic stress symptoms (PTSS) and psychological distress symptoms, and examine for associations with timing of trauma exposure, ongoing adversity and with the sense of injustice in conflict-affected Timor-Leste.SettingA whole-of-household survey was conducted in 2004 and 2010 in Dili, the capital of Timor-Leste.Participants1022 adults were followed up over 6 years (retention rate 84.5%). Interviews were conducted by field workers applying measures of traumatic events (TEs), ongoing adversity, a sense of injustice, PTS symptoms and psychological distress.ResultsLatent transition analysis supported a 3-class longitudinal model (psychological distress, comorbid symptoms and low symptoms). We derived 4 composite trajectories comprising recovery (20.8%), a persisting morbidity trajectory (7.2%), an incident trajectory (37.2%) and a low-symptom trajectory (34.7%). Compared with the low-symptom trajectory, the persistent and incident trajectories reported greater stress arising from poverty and family conflict, higher TE exposure for 2 historical periods, and a sense of injustice for 2 historical periods. The persistent trajectory was unique in reporting greater TE exposure in the Indonesian occupation, whereas the incident trajectory reported greater TE exposure during the later internal conflict that occurred between baseline and follow-up. Compared with the low-symptom trajectory, the incident trajectory reported a greater sense of injustice relating to the periods of the Indonesian occupation and independence. The persistent trajectory was characterised by a sense of injustice relating to the internal conflict and contemporary times. The recovery trajectory was characterised by the absence of these risk factors, the only difference from the low-symptom trajectory being that the former reported a sense of injustice for the period surrounding independence.ConclusionsOur findings suggest that the timing of both TE exposure and the focus of a sense of injustice may differentiate those with persisting and new-onset mental health morbidity in settings of recurrent conflict.

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“…Universal dimensions identified for TEs were conflict-related experiences, witnessing murder, traumatic losses, access to emergency medical care; and for ongoing stressors, extreme poverty, access to basic needs, health care, displacement, safety in the community [4,8,27,28]. These lists were adapted and refined based on our prior knowledge of the history and conditions that prevailed amongst the West Papuan community and our qualitative work with community members.…”

Section: Desk and Team-based Development Of Preliminary Modules Of Tementioning

confidence: 99%

The Refugee-Mental Health Assessment Package (R-MHAP); rationale, development and first-stage testing amongst West Papuan refugees

Tay

Rees

Chen

et al. 2015

Int J Ment Health Syst

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Background:Researchers and practitioners are concerned with a range of inter-related factors that impact on the mental health of refugees, including the traumatic events (TEs) of conflict, conditions of post-migration adversity, and the broader psychosocial disruptions that these societies have experienced. In addition, there is growing recognition that refugees are at risk of a wide range of common mental disorders that include but extend beyond the commonly studied category of post-traumatic stress disorder (PTSD). There is a need therefore to establish an integrated and comprehensive package of measures to assess all elements of relevance to the mental health of refugees. This report describes the rationale, design, development and first stage testing of the four modules (TEs, ongoing adversity, psychosocial impacts, and mental disorder categories/reactions) of the Refugee Mental Health Assessment Package (R-MHAP), drawing on data from a survey of West Papuan refugees (n = 230) residing in Port Moresby, Papua New Guinea. Methods:We detail the sequence of qualitative (based on informant interviews, focus groups) and psychometric tests undertaken in the development of the four modules.Results: Preliminary modules were adapted according to our qualitative findings. Psychometric testing of the relevant modules yielded coherent factorial structures and demonstrated sound convergent and discriminant validity. For TEs, the factors comprised conflict-related experiences, traumatic losses, witnessing murder, childhood adversities, and health stress; for ongoing adversity, factors included deprivation of basic needs, difficulties accessing health care/health problems, displacement, and conditions of safety in the community; and for psychosocial impacts, factors included threats to safety; ruptured relationships; injustice related to past human rights violations; challenges to identity; and existential meaning (related to expression of political aspirations). There was strong agreement in assignment of cases of mental disorder (as a composite grouping) between the R-MHAP administered by field workers and structured clinical interview conducted blind by a psychologist. Symptom means for the majority of diagnostic categories remained stable over a 6-month period. Conclusions:Our first-stage assessment suggests that the R-MHAP holds promise as a comprehensive assessment package for use in the refugee mental health field. et al. Int J Ment Health Syst (2015) 9:29 BackgroundThe research field of refugee and post-conflict mental health spans diverse areas of interest, including exposure to the traumatic events (TEs) of war, conditions of postmigration adversity, the broader psychosocial changes following conflict and forced migration, and a range of common mental disorders. There is a need for a comprehensive package of measures that incorporates key indices of relevance to researchers and practitioners working in the field worldwide. We report the design, development, and first-stage testing of the four modules comprisi...

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Intermittent Explosive Disorder amongst Women in Conflict Affected Timor-Leste: Associations with Human Rights Trauma, Ongoing Violence, Poverty, and Injustice

Cited by 57 publications

References 35 publications

Testing competing factor models of the latent structure of post-traumatic stress disorder and complex post-traumatic stress disorder according to ICD-11

Testing competing factor models of the latent structure of post-traumatic stress disorder and complex post-traumatic stress disorder according to ICD-11

Six-year trajectories of post-traumatic stress and severe psychological distress symptoms and associations with timing of trauma exposure, ongoing adversity and sense of injustice: a latent transition analysis of a community cohort in conflict-affected Timor-Leste

The Refugee-Mental Health Assessment Package (R-MHAP); rationale, development and first-stage testing amongst West Papuan refugees

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