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Posttraumatic Stress Disorder and Psychiatric Co-morbidity among Syrian Refugees of Different Ages: the Role of Trauma Centrality

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Abstract

It has been documented that trauma centrality is associated with posttraumatic stress disorder (PTSD) and psychiatric co-morbidity among Syrian refugees. Whether age would influence the levels of the above constructs and the association between trauma centrality and distress outcomes is unclear. This study compared age differences in 1) the levels of trauma centrality, posttraumatic stress disorder and psychiatric co-morbidity, and 2) models depicting the association between trauma centrality and distress outcomes among Syrian refugees. One thousand one hundred and ninety-seven refugees completed the Centrality of Event Scale, Harvard Trauma Questionnaire and General Health Questionnaire-28. Age groups were divided into young, middle-aged adults and adults of 45 or above. No significant group differences were found in the proportion of refugees meeting the diagnostic criteria for PTSD. Controlling for demographic variables, all subscales of trauma centrality and psychiatric co-morbidity were significantly different between groups. Young adults reported significantly less trauma centrality and psychiatric co-morbidity than the other groups. Multiple-indicator multiple-cause modelling showed that trauma centrality was significantly correlated with PTSD and psychiatric co-morbidity. Multi-group analysis showed the model for the young adult group to be significantly different from the middle-aged group model. To conclude, age did not seem to influence the severity of PTSD among Syrian refugees. The war had a less severe impact on young adults’ sense of self and other psychological problems than those who were older. The way in which young and middle-aged adults responded to distress varied depending on environment and personal characteristics.

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References

  1. Jefee-Bahloul H, Barkil-Oteo A, Pless-Mulloli T, Fouad FM. Mental health in the Syrian crisis: beyond immediate relief. Lancet. 2015;386(10003):1531.

    Article  Google Scholar 

  2. Nassan M, Frye MA, Adi A, Alarcon RD. Telepsychiatry for post-traumatic stress disorder: a call for action in the Syrian conflict. Lancet Psychiatry. 2015;2(10):866.

    Article  Google Scholar 

  3. Khalil RB. Where all and nothing is about mental health: beyond posttraumatic stress disorder for displaced Syrians. Am J Psychiatry. 2013;170(12):1396–7.

    Article  Google Scholar 

  4. Refugees UNHCf. Syria Regional Refugee Response: Inter-agency Information 2015. Available from: http://data.unhcr.org/syrianrefugees/.

  5. Alpak G, Unal A, Bulbul F, Sagaltici E, Bez Y, Altindag A, et al. Post-traumatic stress disorder among Syrian refugees in Turkey: a cross-sectional study. Int J Psychiatry Clin Pract. 2015;19(1):45–50.

    Article  Google Scholar 

  6. Chung MC, AlQarni N, Al Muhairi S, Mitchell B. The relationship between trauma centrality, self-efficacy, posttraumatic stress and psychiatric co-morbidity among Syrian refugees: is gender a moderator? J Psychiatr Res. 2017;94:107–15.

    Article  Google Scholar 

  7. Bernard JD, Whittles RL, Kertz SJ, Burke PA. Trauma and event centrality: valence and incorporation into identity influence well-being more than exposure. Psychol Trauma. 2015;7(1):11–7.

    Article  Google Scholar 

  8. Ogle CM, Rubin DC, Siegler IC. Cumulative exposure to traumatic events in older adults. Aging Ment Health. 2014;18(3):316–25.

    Article  Google Scholar 

  9. Ogle CM, Rubin DC, Siegler IC. Maladaptive trauma appraisals mediate the relation between attachment anxiety and PTSD symptom severity. Psychol Trauma. 2016;8(3):301–9.

    Article  Google Scholar 

  10. Blix I, Solberg O, Heir T. Centrality of event and symptoms of posttraumatic stress disorder after the 2011 Oslo bombing attack. Appl Cogn Psychol. 2014;28(2):249–53.

    Article  Google Scholar 

  11. Boals A. Using event centrality to predict depressive symptoms after a romantic conflict: a prospective design. Appl Cogn Psychol. 2014;28(2):259–65.

    Article  Google Scholar 

  12. Groleau JM, Calhoun LG, Cann A, Tedeschi RG. The role of centrality of events in posttraumatic distress and posttraumatic growth. Psychol Trauma. 2013;5(5):477–83.

    Article  Google Scholar 

  13. Lancaster SL, Klein KR, Nadia C, Szabo L, Mogerman B. An integrated model of posttraumatic stress and growth. J Trauma Dissociation. 2015;16(4):399–418.

    Article  Google Scholar 

  14. Roland AG, Currier JM, Rojas-Flores L, Herrera S. Event centrality and posttraumatic outcomes in the context of pervasive violence: a study of teachers in El Salvador. Anxiety Stress Copin. 2014;27(3):335–46.

    Article  Google Scholar 

  15. Allbaugh LJ, Wright MOD, Folger SF. The role of repetitive thought in determining posttraumatic growth and distress following interpersonal trauma. Anxiety Stress Copin. 2016;29(1):21–37.

    Article  Google Scholar 

  16. Berntsen D, Rubin DC. The centrality of event scale: a measure of integrating a trauma into one's identity and its relation to post-traumatic stress disorder symptoms. Behav Res Ther. 2006;44(2):219–31.

    Article  Google Scholar 

  17. Baltes PB, Nesselroade JR. Paradigm lost and paradigm regained: critique of Dannefer’s portrayal of life-span developmental psychology. Am Sociol Rev. 1984;49:841–7.

    Article  Google Scholar 

  18. Baltes PB, Reese HW, Lipsitt LP. Life-span developmental psychology. Annu Rev Psychol. 1980;31:65–110.

    Article  CAS  Google Scholar 

  19. Charles ST, Mather M, Carstensen LL. Aging and emotional memory: the forgettable nature of negative images for older adults. J Exp Psychol Gen. 2003;132:310–24.

    Article  Google Scholar 

  20. Urry HL, Gross JJ. Emotion regulation in older age. Curr Dir Psychol Sci. 2010;19:352–7.

    Article  Google Scholar 

  21. Berntsen D, Rubin DC. Flashbulb memories and posttraumatic stress reactions across the life span: age-related effects of the German occupation of Denmark during world war II. Psychol Aging. 2006;21(1):127–39.

    Article  Google Scholar 

  22. Boals A, Hayslip B Jr, Knowles LR, Banks JB. Perceiving a negative event as central to one's identity partially mediates age differences in posttraumatic stress disorder symptoms. J Aging Health. 2012;24(3):459–74.

    Article  Google Scholar 

  23. Ogle CM, Rubin DC, Siegler IC. Accounting for posttraumatic stress disorder symptom severity with pre- and posttrauma measures: a longitudinal study of older adults. Clin Psychol Sci. 2016;4(2):272–86.

    Article  Google Scholar 

  24. Shannon PJ, Vinson GA, Wieling E, Cook T, Letts J. Torture, war trauma, and mental health symptoms of newly arrived Karen refugees. J Loss Trauma. 2015;20(6):577–90.

    Article  Google Scholar 

  25. Kroll J, Yusuf AI, Fujiwara K. Psychoses, PTSD, and depression in Somali refugees in Minnesota. Soc Psychiatry Psychiatr Epidemiol. 2011;46(6):481–93.

    Article  Google Scholar 

  26. Robertson CL, Halcon L, Savik K, Johnson D, Spring M, Butcher J, et al. Somali and Oromo refugee women: trauma and associated factors. J Adv Nurs. 2006;56(6):577–87.

    Article  Google Scholar 

  27. Ai AL, Peterson C. Symptoms, religious coping, and positive attitudes of refugees from Kosovar War. Corales, Thomas A [Ed] (2005) Focus on posttraumatic stress disorder research (pp 123–156) xi, 279 pp Hauppauge, NY, US: Nova Science Publishers; US. 2005:123–56.

  28. Marshall GN, Schell TL, Elliott MN, Berthold S, Chun C-A. Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA. 2005;294(5):571–9.

    Article  CAS  Google Scholar 

  29. Bogic M, Ajdukovic D, Bremner S, Franciskovic T, Galeazzi GM, Kucukalic A, et al. Factors associated with mental disorders in long-settled war refugees: refugees from the former Yugoslavia in Germany, Italy and the UK. Br J Psychiatry. 2012;200(3):216–23.

    Article  Google Scholar 

  30. Hinton W, Tiet Q, Tran CG, Chesney M. Predictors of depression among refugees from Vietnam: a longitudinal study of new arrivals. J Nerv Ment Dis. 1997;185(1):39–45.

    Article  CAS  Google Scholar 

  31. Elhabiby MM, Radwan DN, Okasha TA, El-Desouky ED. Psychiatric disorders among a sample of internally displaced persons in South Darfur. Int J Soc Psychiatry. 2015;61(4):358–62.

    Article  Google Scholar 

  32. Priebe S, Gavrilovic JJ, Bremner S, Ajdukovic D, Franciskovic T, Galeazzi GM, et al. Psychological symptoms as long-term consequences of war experiences. Psychopathology. 2012;46(1):45–54.

    Article  Google Scholar 

  33. Molsa M, Punamaki R-L, Saarni SI, Tiilikainen M, Kuittinen S, Honkasalo M-L. Mental and somatic health and pre- and post-migration factors among older Somali refugees in Finland. Transcult Psychiatry. 2014;51(4):499–525.

    Article  Google Scholar 

  34. Weine SM, Becker DF, Vojvoda D, Hodzic E, Sawyer M, Hyman L, et al. Individual change after genocide in Bosnian survivors of "ethnic cleansing": assessing personality dysfunction. J Trauma Stress. 1998;11(1):147–53.

    Article  CAS  Google Scholar 

  35. Drozdek B. Follow-up study of concentration camp survivors from Bosnia-Herzegovina: three years later. J Nerv Ment Dis. 1997;185(11):690–4.

    Article  CAS  Google Scholar 

  36. Carta M, Oumar F, Moro M, Moro D, Preti A, Mereu A, et al. Trauma- and stressor related disorders in the Tuareg refugees of a camp in Burkina Faso. Clin Pract Epidemiol Ment Health. 2013;9:189–95.

    Article  CAS  Google Scholar 

  37. Mollica R, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard trauma questionnaire: validating a cross-cultural instrument for measuring torture, trauma and posttraumatic stress disorder in indochinese refugees. J Nerv Ment Dis. 1992;180:111–6.

    Article  CAS  Google Scholar 

  38. Goldberg D, Hillier V. A scaled version of the general health questionnaire. Psychol Med. 1979;9:139–45.

    Article  CAS  Google Scholar 

  39. Goldberg D, Bridges KW. Screening for psychiatric illness in general practice: the general practitioner versus the screening questionnaire. J Royal College Gen Pract. 1987;37:15–8.

    CAS  Google Scholar 

  40. Scott SB. A lifespan perspective on terrorism: age differences in trajectories of response to 9/11. Dev Psychol. 2013;49:986–98.

    Article  Google Scholar 

  41. Friedman M, Keane T, Resick P. Handbook of PTSD: science and practice. New York: Guilford; 2007.

    Google Scholar 

  42. Vogt D, King D, King L. Risk pathways in PTSD: making sense of the literature. In: Friedman M, Kean T, Resick P, editors. Handbook of PTSD: science and practice. New York: Guildford; 2007. p. 99–116.

    Google Scholar 

  43. Weintraub D, Ruskin PE. Posttraumatic stress disorder in the elderly: a review. Harv Rev Psychiatry. 1999;7:144–52.

    Article  CAS  Google Scholar 

  44. Chung MC, Dennis I, Easthope Y, Farmer S, Werrett J. Differentiating posttraumatic stress between elderly and younger residents. Psychiatry. 2005;68(2):164–73.

    Article  Google Scholar 

  45. Chatterjee S, Rath ME, Spiro A, Eisen S, Sloan KL, Rosen AK. Gender differences in veterans health administration mental health service use: effects of age and psychiatric diagnosis. Womens Health Issues. 2009;19:176–84.

    Article  Google Scholar 

  46. Lahad M, Leykin D. Ongoing exposure versus intense periodic exposure to military conflict and terror attacks in Israel. J Trauma Stress. 2010;23:691–8.

    Article  Google Scholar 

  47. Chung MC, Preveza E, Papandreou K, Prevezas N. Spinal cord injury, posttraumatic stress, and locus of control among the elderly: a comparison with young and middle-aged patients. Psychiatry. 2006;69(1):69–80.

    Article  Google Scholar 

  48. Green BL, Gleser GC, Lindy JD, Grace MC, Leonard A. Age-related reactions to the Buffalo Creek Dam collapse: effects in the second decade. In: Ruskin PE, Talbott JA, editors. Aging and posttraumatic stress disorder. Washington, D.C: American Psychiatric Press; 1996.

    Google Scholar 

  49. Spitzer C, Barnow S, Völzke H, John U, Freyberger HJ, Grabe HJ. Trauma and posttraumatic stress disorder in the elderly: findings from a German community study. J Clin Psychiatry. 2008;69:693–700.

    Article  Google Scholar 

  50. Norris FH, Kaniasty K, Conrad M, Inman GL, Murphy AD. Placing age differences in cultural context: a comparison of the effects of age on PTSD after disasters in the United States, Mexico and Poland. J Clin Geropsychol. 2002;8:153–73.

    Article  Google Scholar 

  51. Erikson EH. Identity: youth and crisis. New York: Norton; 1968.

    Google Scholar 

  52. Renshaw TL, Furlong MJ, Dowdy E, Rebelez J, Smith DC. Covitality: a synergistic conception of adolescents’ mental health. In: Furlong MJ, Gilman R, Huebner ES, editors. Handbook of positive psychology in schools. New York: Routledge; 2014.

    Google Scholar 

  53. Carstensen LL, Fung H, Charles S. Socioemotional selectivity theory and the regulation of emotion in the second half of life. Motiv Emot. 2003;27:103–23.

    Article  Google Scholar 

  54. Hobfoll SE. Conservation of resources: a new attempt at conceptualizing stress. Am Psychol. 1989;44:513–24.

    Article  CAS  Google Scholar 

  55. Elwell F, Maltbie-Crannel AD. The impact of role loss upon coping resources and life satisfaction of the elderly. J Gerontol. 1981;36:223–32.

    Article  CAS  Google Scholar 

  56. Fillenbaum GG. An examination of the vulnerability hypothesis. Int J Aging Hum Dev. 1977–1978;8:155–60.

    Article  Google Scholar 

  57. Arnett JJ. Emerging adulthood in Europe: a response to Bynner. J Youth Stud. 2006;9:111–23.

    Article  Google Scholar 

  58. Tanner JL, Arnett JJ. The emergence of "emerging adulthood": the new life stage between adolescence and young adulthood. In: Furlong A, editor. Handbook of youth and young adulthood. London: Routledge; 2009. p. 39–45.

    Google Scholar 

  59. Kimerling R, Ouimette P, Weitlauf JC. Gender issues in PTSD. In: Friedman MJ, Keane TM, Resick PA, editors. Handbook of PTSD: science and practice. New York: The Guilford Press; 2007. p. 207–28.

    Google Scholar 

  60. Renner W, Salem I. Post-traumatic stress in asylum seekers and refugees from Chechnya, Afghanistan, and West Africa: gender differences in symptomatology and coping. Int J Soc Psychiatry. 2009;55(2):99–108.

    Article  Google Scholar 

  61. Malatesta VJ. Introduction: the need to address older women's mental health issues. J Women Aging. 2007;19(1–2):1–12.

    Article  Google Scholar 

  62. Chung MC, Jalal S, Khan NU. Posttraumatic stress symptoms, co-morbid psychiatric symptoms and distorted cognitions among flood victims of different ages. J Ment Health. 2016;

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Acknowledgements

The research reported in this paper was funded by a grant from Zayed University in the United Arab Emirates.

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Correspondence to Man Cheung Chung.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Chung, M.C., AlQarni, N., AlMazrouei, M. et al. Posttraumatic Stress Disorder and Psychiatric Co-morbidity among Syrian Refugees of Different Ages: the Role of Trauma Centrality. Psychiatr Q 89, 909–921 (2018). https://doi.org/10.1007/s11126-018-9586-3

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