Complex posttraumatic stress disorder in intergenerational trauma transmission among Eritrean asylum-seeking mother-child dyads.

Background: Traumatic stress among forcibly displaced people has a variety of adverse consequences beyond individual mental health, including implications for poor socioemotional developmental outcomes for their children post-displacement.Objective: This study explored the intergenerational transmission of maternal ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) and depression among asylum-seeking mothers for their children's internalizing and externalizing difficulties.Method: Participants were 127 trauma-affected Eritrean mothers of preschool-aged children in Israel. The severity of child difficulties was compared between mothers with probable ICD-11 CPTSD (94.5% comorbid depression), ICD-11 PTSD (48.5% comorbid depression), unimorbid depression, and healthy mothers, using multivariate analyses of variance, while controlling for children's direct exposure to adverse life experiences.Results: Probable ICD-11 CPTSD and PTSD were present in 23.6% and 26.0% of mothers, respectively. Relative to maternal PTSD, CPTSD was significantly and strongly associated with elevated child internalizing symptoms (d = 2.44) and marginally significantly, although strongly, associated with child externalizing symptoms (d = 1.30). Post-hoc exploratory analyses documented that, relative to maternal PTSD and depression, CPTSD and depression comorbidity was marginally significantly but strongly associated with child internalizing (SMD = .67), but not externalizing symptoms (SMD = .35).Conclusions: Findings implicate maternal CPTSD and comorbid depression in child socio-emotional development and inform clinical assessment, prevention, and intervention to attenuate poor development among children in unstable post-displacement settings.

Trauma among forcibly displaced people has a variety of aversive multisystemic consequences, compromising the socioemotional development of non-exposed children.ICD-11 complex posttraumatic stress disorder (CPTSD) and comorbid depression may be functionally important to elevated risk for maternal intergenerational trauma transmission, even relative to ICD-11 posttraumatic stress disorder (PTSD).To effectively attenuate intergenerational transmission of trauma post-displacement, efforts and resources should be invested in maternal mental health care as well as socio-culturally adapted, trauma-sensitive parenting training.

COVID-19 and Mental Health Among People Who Are Forcibly Displaced: The Role of Socioeconomic Insecurity.

OBJECTIVE: Forcibly displaced persons may be at elevated risk for poor mental health outcomes because of the COVID-19 pandemic. This study sought to examine associations between COVID-19-related socioeconomic insecurity and mental health outcomes among asylum seekers. METHODS: The authors evaluated the association between the degree of food, housing, and income insecurity related to the pandemic and mental health outcomes among East African asylum seekers in a high-risk, postdisplacement setting in the Middle East (i.e., Israel). RESULTS: Anxiety symptom severity (p=0.03) as well as the rate of suicidal ideation among women (odds ratio [OR]=2.81, p=0.016) were significantly elevated in a community sample of asylum seekers during the COVID-19 pandemic (N=66) relative to a similar sample (N=158) from the same community and context assessed before the pandemic. No differences between the two groups were observed for severity or rate of probable depression or posttraumatic stress disorders. In addition, among the sample assessed during the pandemic, socioeconomic insecurity due to the pandemic was strongly associated with elevated symptom severity and probable anxiety, depression, and posttraumatic stress disorders as well as suicidal ideation (R2 range=0.19-0.35; OR range=4.54-5.46). CONCLUSIONS: Findings are consistent with growing evidence of a mental health crisis among asylum seekers that is linked to COVID-19 control policies and residential status policies. The results highlight the risk for suicidal ideation linked to intersectional marginalization among female asylum seekers. These findings may inform postdisplacement policy making, social justice advocacy, humanitarian aid, and clinical science and practice to mitigate poor mental health outcomes associated with COVID-19 among forcibly displaced persons.

Effect of mindfulness-based trauma recovery for refugees on shame and guilt in trauma recovery among African asylum-seekers.

We sought to, first, better understand the role of emotional responding, and specifically shame and guilt, in trauma recovery among asylum-seekers following forced displacement; and, second, to explore whether therapeutic effects of a mindfulness- and compassion-based intervention on trauma recovery among asylum-seekers are mediated by therapeutic effects of the intervention on shame and guilt. Study aims were tested through a randomized waitlist-controlled trial of a 9-week Mindfulness-Based Trauma Recovery for Refugees program among a community sample of 158 Eritrean asylum-seekers (55.7% female) residing in an unstable high-risk urban postdisplacement setting in the Middle East (Israel). First, in a cross-product test of parallel mediation, we found that shame, but not guilt, mediated the preintervention associations between traumatic stress exposure history, as well as current postmigration living difficulties, and current posttraumatic stress (abShame = .035, 95% CI [.024, .048], abShame = .183, 95% CI [.122, .249]) and depression (abShame = .384, 95% CI [.234, .55], abShame = .405, 95% CI [1.117, 2.693]) symptom severity. Second, in a linear mixed effects model of mediation, we found that reduced shame from pre- to postintervention, mediated the effect of MBTR-R, relative to waitlist control, on improved posttraumatic stress (ACMEShame = -.18, BCa 95% CI [-.34, -.04]) and depression (ACMEShame = -1.78, BCa 95% CI [-3.29, -.29]) symptom severity outcomes. Findings provide insight into the potential role of shame in trauma- and stress-related recovery among FDPs (forcibly displaced people). Findings indicate that mindfulness- and compassion-based training promotes trauma recovery, in part, through reducing feelings of shame postdisplacement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Candidate mechanisms of action of mindfulness-based trauma recovery for refugees (MBTR-R): Self-compassion and self-criticism.

OBJECTIVE: Mindfulness- and compassion-based interventions may represent a promising intervention approach to the global mental health crisis of forced displacement. Specifically, Mindfulness-Based Trauma Recovery for Refugees (MBTR-R)-a mindfulness- and compassion-based, trauma-sensitive, and socioculturally adapted intervention for refugees and asylum-seekers-has recently demonstrated randomized control evidence of therapeutic efficacy and safety. Yet, little is known about potential mechanisms underlying these therapeutic effects for trauma recovery and for refugees and asylum-seekers. METHOD: Thus, we examined adaptive and maladaptive forms of self-referentiality, namely self-compassion and self-criticism, as mechanisms of action for trauma recovery in a randomized wait-list control trial of MBTR-R among a community sample of 158 traumatized and chronically stressed asylum-seekers (46% female) in an urban postdisplacement setting (Middle East). Self-compassion and self-criticism were measured vis-à-vis an experimental Self-Referential Encoding Task (SRET) designed to quantify cognitive processes underlying self-compassion and self-criticism using diffusion modeling, a computational modeling approach to quantify cognitive processes underlying decision-making from behavioral reaction time data. RESULTS: Findings indicate that self-compassion and self-criticism were associated with trauma- and stress-related psychopathology at preintervention. Relative to wait-list controls, MBTR-R led to significant elevation in self-compassion, and reduction in self-criticism, from pre to postintervention. Finally, pre to postintervention change in self-criticism significantly mediated therapeutic effects of MBTR-R on depression and posttraumatic stress disorder (PTSD) outcomes, while pre to postintervention change in self-compassion only mediated therapeutic effects on PTSD outcomes. CONCLUSIONS: Findings speak to the importance of (mal)adaptive self-referentiality as a target mechanism in MBIs and trauma recovery broadly, and among refugees and asylum-seekers specifically. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Functional Network Perspective on Posttraumatic Stress in Refugees: Implications for Theory, Classification, Assessment, and Intervention.

There is an important, long-standing debate regarding the universality vs. specificity of trauma-related mental health symptoms in socio-culturally and linguistically diverse population groups, such as refugees and asylum seekers. Network theory, an emerging development in the field of psychological science, provides a novel data analytic methodology to evaluate and empirically examine long-standing questions about the structure and function of posttraumatic stress symptoms. We sought to empirically model the functional network of posttraumatic stress symptoms among East African refugees who survived multiple potentially traumatic events. A sample of 148 Sudanese and Eritrean male asylum seekers (M(SD)age = 32.60(7.13) were recruited from the community in Israel. The nature and function(s) of posttraumatic symptoms (Harvard Trauma Questionnaire) were modeled using regularized partial correlation models to derive a network of symptoms. Spinglass and exploratory graph analysis walktrap algorithms were then used to identify functional "circuits of symptoms" or clusters of nodes within the network. Analyses revealed a functional symptom circuitry that shares features with the predominant western model of posttraumatic stress disorder; as well as unique functional clusters of symptoms inconsistent with nosology and symptomatology observed in studies of Western populations. Findings may have important implications for theory, classification, assessment, candidate mechanisms that may drive and maintain posttraumatic stress, and in turn may inform prevention or treatment for socio-culturally diverse forcibly displaced population groups.

Avoidance in posttraumatic stress among refugee survivors of violent conflict and atrocities: Testing trans-cultural risk processes and candidate intervention targets.

BACKGROUND: A fast-growing population of refugees and survivors of violent conflict and atrocities are at risk for trauma-related mental health problems. Experimental clinical research key to the development of interventions tailored to this population is limited. AIMS: In an experimental psychopathology laboratory paradigm, we tested the expression and function of avoidance in posttraumatic stress (PTS) among a highly traumatized community sample of forcibly displaced refugees seeking asylum. METHOD: We measured behavioral avoidance and emotional reactivity to repeated exposure to threatening stimuli (trauma-, war-, and geographically-relevant natural threat) in 110 Sudanese male asylum seekers (M(SD)age = 32.7(6.5)) recruited from the community in Israel. RESULTS: First, we found evidence of sensitization - traumatized refugees expressed increasing levels of behavioral avoidance and emotional reactivity in response to repeated exposure to threatening stimuli. Second, as predicted, refugees suffering from more severe PTS were more likely to exhibit greater behavioral avoidance and emotional reactivity reflexively or immediately upon exposure to threat stimuli. Finally, as predicted, behavioral avoidance mediated the effect of PTS severity on emotional reactivity to threat exposure. CONCLUSIONS: Findings are consistent with theorizing that avoidance may function as a trans-cultural malleable risk process sub-serving PTS and thereby a promising intervention target among highly traumatized refugees from E. Africa.

Self-compassion in recovery following potentially traumatic stress: longitudinal study of at-risk youth.

Despite promising theory, empirical study of the putative protective properties of self-compassion (SC) with respect to resilience to and recovery from traumatic stress is limited. The present study tested the theorized protective role(s) of SC with respect to trauma-related psychopathology over time among an at-risk sample of adolescents (N = 64, 26 % females, M(SD) age = 17.5(1.07) years-old, range age = 15-19; grades 9-12) directly exposed to a potentially traumatic stressful event - the Mount Carmel Forest Fire Disaster. The longitudinal design involved three assessment time-points - within 30-days of the potentially traumatic event (T1) and then at 3- (T2) and 6-months (T3) follow-up intervals. Consistent with prediction, multi-level modeling of mediation documented the prospective protective function(s) of SC, above and beyond dispositional mindfulness, with respect to posttraumatic stress and panic symptoms, depressive symptoms, and suicidality symptoms, but not well-being. The findings are discussed, theoretically, with respect to SC as a malleable protective factor for trauma-related psychopathology outcomes; and, clinically, with respect to SC as a target for future trauma-related selective-prevention and -early intervention research.