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

Abstract

Background Psychological distress due to the ongoing war, violence, and persecution is particularly common among Afghan asylum seekers and refugees. In addition, individuals face a variety of post-migration living difficulties (PMLDs). Complex posttraumatic stress symptoms are among the most common mental health problems in this population, and were associated with the overall burden of PMLDs. The complex interplay of posttraumatic symptoms has been investigated from a network perspective in previous studies. However, individuals are embedded in and constantly react to the environment, which makes it important to include external factors in network models to better understand the etiology and maintaining factors of posttraumatic mental health problems. PMLDs are a major risk factor for posttraumatic distress and considering their impact in interventions might improve response rates. However, the interaction of these external factors with posttraumatic psychopathological distress is not yet fully understood. Thus, we aimed to illuminate the complex interaction between PMLDs and CPTSD symptom clusters. Objective The main objective is the exploration of the network structure and the complex interplay of ICD-11 CPTSD symptom clusters and distinct forms of PMLDs. Method The symptom clusters of CPTSD and PMLDs were collected within a randomised controlled trial among 93 treatment-seeking Afghan asylum seekers and refugees via a fully structured face-to-face and interpreter assisted interview. Using a network analytical approach, we explored the complex associations and network centrality of the CPTSD symptom clusters and the PMLD factors: discrimination & socio-economical living conditions, language acquisition & barriers, family concerns, and residence insecurity. Results The results suggest direct links within and between the constructs (CPTSD, PMLD). Almost all PMLD factors were interrelated and associated to CPTSD, family concerns was the only isolated variable. The CPTSD symptom cluster re-experiencing and the PMLD factor language acquisition & barriers connected the two constructs. Affective dysregulation had the highest and avoidance the lowest centrality. Conclusions Re-experiencing and affective dysregulation have the strongest ties to PMLDs. Thus, these domains might explain the strong association of posttraumatic psychopathology with PLMDs and, consequently, prioritization of these domains in treatment approaches might both facilitate treatment response and reduce burden caused by PMLDs.

Afghan mental health and psychosocial well-being: thematic review of four decades of research and interventions

“…98 Poor mental health lingers for long periods after resettlement, 99 given that the associations between trauma exposure and clinical symptoms are moderated through the presence of ongoing stressors and loss of coping resources. 100 Post-resettlement stressors include a state of precarity with regards to residence status, 101,102 loneliness, 93,103 acculturation difficulties, 104 unemployment, intergenerational conflicts, 59 gender role changes, 105,106 discrimination, 107 education and inclusion. 108,109…”

Complex post-traumatic stress disorder: a much needed diagnosis

“…For example, experiences of discrimination have been found to have a strong association with negative self-concept, while residency instability has been associated with re-experiencing symptoms. 11 These results highlight the complex dynamics between history of trauma, the presence of ongoing stressors and trauma-related mental health symptoms.…”

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

“…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). There were no associations between PTSDICD-11 or cPTSD and employment (60,62,64,66), family concerns (65,72), residence insecurity, socioeconomic living conditions and discrimination (72), legal status (64), and being with family (60).…”

“…Thirteen studies reported PTSDICD-11 prevalence rates (Figure 3), which ranged from 0.4% (59) to 80% (48). Prevalence rates were higher in clinical samples (14.4% to 80%) (48,(60)(61)(62)(63)(64)(65)(66)(67) than in representative samples (0.4% to 20.9%) (43,58,59). The pooled prevalence of PTSDICD-11 was 21.3%.…”