RESUMEN
The levels of exposure to conflict-related trauma and the high rates of mental health impairment amongst asylum seekers pose specific challenges for refugee decision makers who lack mental health training. We examined the use of psychological evidence amongst asylum decision makers in New South Wales, Australia, drawing on the archives of a representative cohort of 52 asylum seekers. A mixed-method approach was used to examine key mental health issues presented in psychological reports accompanying each asylum application, including key documents submitted for consideration of asylum at the primary and review levels. The findings indicated that the majority of decision makers at both levels did not refer to psychological evidence in their decision records. Those who did, particularly in the context of negative decisions, challenged the expert findings and rejected the value of such evidence. Asylum seekers exhibiting traumatic stress symptoms such as intrusive thoughts and avoidance, as well as memory impairment, experienced a lower acceptance rate than those who did not across the primary and review levels. The findings raise concern that trauma-affected asylum seekers may be consistently disadvantaged in the refugee decision-making process and underscore the need to improve the understanding and use of mental health evidence in the refugee decision-making setting. The study findings have been used to develop a set of guidelines to assist refugee decision makers, mental health professionals and legal advisers in improving the quality and use of psychological evidence within the refugee decision-making context.
Asunto(s)
Toma de Decisiones , Emigración e Inmigración/legislación & jurisprudencia , Testimonio de Experto , Refugiados/psicología , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Servicios de Salud Mental , Persona de Mediana Edad , Nueva Gales del Sur , Refugiados/estadística & datos numéricos , Trastornos por Estrés Postraumático/diagnósticoRESUMEN
OBJECTIVES: To document the extent and nature of human rights violations and other traumatic events reported by West Papuan refugees resettled in Australia and to assess trauma-related psychological disorders, distress and disability. DESIGN AND SETTING: Australian-based sample, mixed-methods design with 44 participants, conducted in Australia between October 2007 and November 2010 in communities in North Queensland and Melbourne. PARTICIPANTS: West Papuan refugees aged 18 years and over (88% response rate). MAIN OUTCOME MEASURES: Post-traumatic stress disorder (PTSD) symptoms (Harvard Trauma Questionnaire) and premigration potentially traumatic events (PTEs), psychological distress (Kessler Psychological Distress Scale [K10]), post-migration living difficulties, days out of role. RESULTS: Of the 44 West Papuan refugees, 40 reported one or more PTE, including inability to access medical care for family (40), lack of food and water (39) and lack of access to medical treatment (38). The most frequent postmigration stressors were separation from and worries about family members remaining in West Papua (43) and being unable to return home in an emergency because of ongoing conflict (41). Twenty-six participants reached a lower threshold for PTSD symptoms of 2.0, and 13 reached the clinical threshold of 2.5. Fourteen reported severe psychological distress. CONCLUSIONS: West Papuan refugees resettled in Australia report a wide range of premigration PTEs including human rights violations, as well as symptoms of PTSD and distress. The data add to concerns about the state of human rights and mental health among West Papuans.
Asunto(s)
Emigrantes e Inmigrantes/psicología , Derechos Humanos/psicología , Salud Mental/etnología , Refugiados/psicología , Trastornos por Estrés Postraumático/etnología , Adulto , Australia/epidemiología , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Papúa Nueva Guinea/etnología , Refugiados/estadística & datos numéricos , Factores de Riesgo , Trastornos por Estrés Postraumático/psicología , Violencia/psicología , Violencia/estadística & datos numéricos , Adulto JovenRESUMEN
INTRODUCTION: Women in conflict-affected countries are at risk of mental disorders such as posttraumatic stress disorder and depression. No studies have investigated the association between experiences of abuse and injustice and explosive anger amongst women in these settings, and the impact of anger on women's health, family relationships and ability to participate in development. METHODS: A mixed methods study including an epidemiological survey (n = 1513, 92.6% response) and qualitative interviews (n = 77) was conducted in Timor-Leste. The indices measured included Intermittent Explosive Disorder, posttraumatic stress disorder; severe distress; days out of role (the number of days that the person was unable to undertake normal activities); gender-specific trauma; conflict/violence; poverty; and preoccupations with injustice. RESULTS: Women with Intermittent Explosive Disorder (nâ=â184, 12.2%) were more disabled than those without the disorder (for >5 days out of role, 40.8% versus 31.5%, X(2) (2) = 12.93 p = 0.0016). Multivariable associations with Intermittent Explosive Disorder, controlling for the presence of PTSD, psychological distress and other predictors in the model, included the sense of being sick (OR 1.73; 95% CI 1.08-2.77); victimization as a result of helping the resistance movement (OR 2.33, 95% CI 1.48-3.68); war-related trauma specific to being a woman (OR 1.95, 95%, CI 1.09-3.50); ongoing family violence and community conflict (OR 1.88, 95% CI 1.27-2.77); extreme poverty (OR 1.23, 95%, CI 1.08-1.39); and distressing preoccupations with injustice (relating to 2/3 historical periods, OR 2.10, 95% CI 1.35-3.28). In the qualitative study, women elaborated on the determinants of anger and its impact on their health, family and community functioning, child-rearing, and capacity to engage in development. Women reflected on the strategies that might help them overcome their anger. CONCLUSIONS: Intermittent Explosive Disorder is prevalent and disabling amongst women in conflict-affected Timor-Leste, impacting on their health, child-rearing and ability to participate fully in socio-economic development.
Asunto(s)
Conflicto Psicológico , Trastornos Disruptivos, del Control de Impulso y de la Conducta/psicología , Encuestas Epidemiológicas/estadística & datos numéricos , Salud de la Mujer/estadística & datos numéricos , Adulto , Personas con Discapacidad/psicología , Personas con Discapacidad/estadística & datos numéricos , Trastornos Disruptivos, del Control de Impulso y de la Conducta/epidemiología , Femenino , Encuestas Epidemiológicas/métodos , Violaciones de los Derechos Humanos/psicología , Violaciones de los Derechos Humanos/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Pobreza/psicología , Pobreza/estadística & datos numéricos , Prevalencia , Salud Rural/estadística & datos numéricos , Justicia Social/psicología , Justicia Social/estadística & datos numéricos , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Timor Oriental/epidemiología , Salud Urbana/estadística & datos numéricos , Violencia/psicología , Violencia/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: There is growing research interest in understanding and analyzing explosive forms of anger. General epidemiological studies have focused on the DSM-IV category of Intermittent Explosive Disorder (IED), while refugee and post-conflict research have used culturally-based indices of explosive anger. The aim of this study was to test the convergence of a culturally-sensitive community measure of explosive anger with a structured clinical interview diagnosis of IED in Timor-Leste, a country with a history of significant mass violence and displacement. METHODS: A double-blind clinical concordance study was conducted amongst a stratified community sample in post-conflict Timor-Leste (n=85) to compare a community measure of anger against the Structured Clinical Interview (SCID) module for IED. RESULTS: Clinical concordance between the two measures was high: the area under the curve (AUC) index was 0.90 (95% CI: 0.83-0.98); sensitivity and specificity were 93.3% and 87.5% respectively. LIMITATIONS: Response rates were modest due to the participant's time commitments. CONCLUSIONS: It is possible to achieve convergence between culturally-sensitive measures of explosive anger and the DSM-IV construct of IED, allowing comparison of findings across settings and populations.