Dataset Information

Formative psychosocial evaluation using dynamic networks: trauma, stressors, and distress among Darfur refugees living in Chad.

ABSTRACT:

Background

Research on the impact of various types of stressors on refugee wellbeing may not readily inform those designing interventions about the supports that will be most helpful in particular settings. Composite variables used in psychosocial research that represent overarching types of stressors provide only vague information about intervention targets. Dynamic networks model individual phenomena separately (i.e., specific stressors and symptoms of distress) to inform how phenomena interact with each other in ways that may be useful for individuals planning interventions in humanitarian aid settings.

Methods

Using archival data from Darfur refugees, we used a dynamic networks approach to model relationships between locally-validated measures of traumatic events, displacement stressors, impairment, and distress.

Results

Findings aligned with previous research on the centrality of basic needs in refugee populations. Further, specific stressors were highlighted as particularly impactful for this population, and sleep and physical difficulties emerged as key aspects of distress and impairment, suggesting areas for targeted intervention. Conclusions: Dynamic network approaches may be fruitful for identifying setting-specific intervention targets and maximizing the impact of limited resources in humanitarian aid settings.

SUBMITTER: Mootoo C

PROVIDER: S-EPMC6595582 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

Formative psychosocial evaluation using dynamic networks: trauma, stressors, and distress among Darfur refugees living in Chad.

Mootoo Candace C Fountain Christine C Rasmussen Andrew A

Conflict and health 20190626

<h4>Background</h4>Research on the impact of various types of stressors on refugee wellbeing may not readily inform those designing interventions about the supports that will be most helpful in particular settings. Composite variables used in psychosocial research that represent overarching types of stressors provide only vague information about intervention targets. Dynamic networks model individual phenomena separately (i.e., specific stressors and symptoms of distress) to inform how phenomena ...[more]

PMID: 31391864

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Project description:BackgroundThe effects of treatment in trials with trauma-affected refugees vary considerably not only between studies but also between patients within a single study. However, we know little about why some patients benefit more from treatment, as few studies have analysed predictors of treatment outcome.ObjectiveThe objective of the study was to examine possible psychosocial predictors of treatment outcome for trauma-affected refugees.MethodThe participants were 195 adult refugees with posttraumatic stress disorder (PTSD) who were enrolled in a 6- to 7-month treatment programme at the Competence Centre for Transcultural Psychiatry (CTP), Denmark. The CTP Predictor Index used in the study included 15 different possible outcome predictors concerning the patients' past, chronicity of mental health problems, pain, treatment motivation, prerequisites for engaging in psychotherapy, and social situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms Checklist-90, Global Assessment of Functioning scales, and pain rated on visual analogue scales. The relations between treatment outcomes and the total score as well as subscores of the CTP Predictor Index were analysed.ResultsOverall, the total score of the CTP Predictor Index was significantly correlated to pre- to post treatment score changes on the majority of the ratings mentioned above. While employment status was the only single item significantly correlated to HTQ-score changes, a number of single items from the CTP Predictor Index correlated significantly with changes in depression and anxiety symptoms, but the size of the correlation coefficients were modest.ConclusionsThe total score of the CTP Predictor Index correlated significantly with outcomes on most of the rating scales, but correlations were modest in size, possibly due to the number of different factors influencing treatment outcome.

Project description:Psychosocial stressors are indicative of challenges associated with the social and environmental conditions an individual is subjected to. In a bid to clearly understand the present gaps in school sanitation, this cross-sectional study aimed to identify the sanitation-related psychosocial stressors experienced by students in a Nigerian peri-urban community and their associated impacts. A three-stage sampling technique was used to select 400 students from 10 schools. The students to toilet ratio were 1,521:0 and 1,510:0 for the public-school boys and girls, respectively, and 74:1 and 70:1 for the private-school boys and girls, respectively. Furthermore, public-school students had a significantly higher average stress level (P < 0.001, η2p = 0.071) and a significantly higher proportion of students experiencing school absenteeism (P < 0.001; odds ratio [OR] = 4.8; 95% confidence interval [CI] = 2.7-8.2), missed classes (P < 0.001; OR = 5.8; CI = 2.8-12.0), long urine/fecal retention time (P < 0.001; OR = 2.9; CI = 1.8-4.7), open defecation practice (P < 0.001; OR = 4.2; CI = 2.5-7.1), and open defecation-related anxiety (P < 0.001; OR = 3.6; CI = 2.0-6.5). Moreover, the inability to practice menstrual hygiene management was significantly associated with student-reported monthly school absence among girls (P < 0.001; OR = 4.5; CI = 2.2-9.4). Overall, over 50% of the respondents had reportedly been subjected to at least 14 of the 17 stressors outlined. The most prevalent stressors identified were concerns about disease contraction, toilet cleanliness, toilet phobia, privacy, and assault/injury during open defecation/urination. In conclusion, results show that the absence of functional sanitation facilities purportedly has a grievous effect on the mental, physical, social, and academic well-being of the students. This was clearly seen among public-school students. Subsequent sanitation interventions need to be targeted at ameliorating identified stressors.

Project description:Documentation is limited in relation to the mental health of the people of West Papua, a territory that has been exposed to decades-long political persecution. We examined associations of traumatic events (TEs) and current stressors with mental disorder and functioning, amongst 230 West Papuan refugees residing in six settlements in Port Morseby, Papua New Guinea (PNG). We used culturally adapted modules to assess exposure to TEs and mental disorders. Current stressors and functioning were assessed using modifications of measures developed by the World Health Organization (WHO). 129 of 230 respondents (56%) reported exposure to at least one traumatic event (TE), including: political upheaval (36.5%), witnessing or hearing about family members tortured and murdered (33.9%), and not being able to access medical care for family members (33%). One fifth of respondents (47, 20.4%) experienced exposure to high levels of TEs (16 to 23). 211 (91.7%) endorsed at least one or more ongoing stressors, including: exposure to illicit substance use in the community (91.7%), problems with safety and the protection of women (89.6%), no access to legal rights and citizenship (88.3%), and lack of adequate shelter and facilities (85.2%). A quarter (26.9%) met criteria for one or more current mental disorder, and 69.1% reported functional impairment ranging from mild to extreme. Mental disorder was associated with being male (adjusted odds ratio=2.00; 95% CI=1.01-3.97), and exposure to the highest category of ongoing stressors (AOR=2.89; 95% CI=1.08-7.72). The TE count showed a dose-response pattern in its relationship with functional impairment, the greatest risk (AOR=11.47; 95% CI=2.11-62.37) being for those experiencing the highest level of TE exposure (16-23 events). West Papuans living in settlements in Port Moresby reported a range of TEs, ongoing stressors and associated mental disorders characteristic of populations exposed to mass conflict and persecution, prolonged displacement, and ongoing conditions of extreme hardship.

Project description:ObjectiveTo study the relation among psychosocial stressors, long-standing distress and incidence of dementia, in a sample of women followed from midlife to late life.DesignProspective longitudinal population study.SettingThe analyses originate from the prospective population study of women in Gothenburg, Sweden, a representative sample of women examined in 1968 (participation rate 90%) and re-examined in 1974, 1980, 1992, 2000 and 2005.Participants800 women born in 1914, 1918, 1922 and 1930 who were systematically selected for a psychiatric examination at baseline, in 1968.Primary and secondary outcome measures18 psychosocial stressors (eg, divorce, widowhood, work problems and illness in relative) were obtained at baseline. Symptoms of distress were measured according to a standardised question at each study wave. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data, and measured through the whole study period.ResultsDuring the 37 years of follow-up, 153 women developed dementia (104 of those had Alzheimer's disease (AD)). Number of psychosocial stressors in 1968 was associated (HR, 95% CI) with higher incidence of dementia (1.15, 1.04 to 1.27) and AD (1.20, 1.07 to 1.35) between 1968 and 2005, in multivariate Cox regressions. Number of psychosocial stressors in 1968 was also associated (OR, 95% CI) with distress in 1968 (1.48, 1.32 to 1.67), 1974 (1.31, 1.17 to 1.46), 1980 (1.27, 1.11 to 1.45), 2000 (1.39, 1.14 to 1.70) and 2005 (1.35, 1.02 to 1.79), in multivariate logistic regressions. Number of psychosocial stressors (HR 1.17, 95% CI 1.03 to 1.33) and long-standing distress (1968-1974-1980) (HR 1.58, 95% CI 1.03 to 2.45) were independently associated with AD.ConclusionsOur study shows that common psychosocial stressors may have severe and long-standing physiological and psychological consequences. However, more studies are needed to confirm these results and investigate whether more interventions such as stress management and behavioural therapy should be initiated in individuals who have experienced psychosocial stressors.

Dataset Information

Formative psychosocial evaluation using dynamic networks: trauma, stressors, and distress among Darfur refugees living in Chad.

Background

Methods

Results

Publications

Formative psychosocial evaluation using dynamic networks: trauma, stressors, and distress among Darfur refugees living in Chad.

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