Faculty Bibliography

Darfur refugees face hardships associated with chronic displacement, including lack of basic needs and safety concerns. Psychiatric research on refugees has focused on trauma, but daily stressors may contribute more to variance in distress. This article reports rates of past trauma and current stressors among Darfur refugees and gauges the contribution of each to psychological distress and functional impairment. A representative sample of 848 Darfuris in 2 refugee camps were interviewed about traumatic events, stressors faced in the camps, psychological distress, and functional impairment. Basic needs and safety concerns were more strongly correlated with measures of distress (rs = .19-.31) than were war-related traumatic events (rs = .09-.20). Hierarchical regression supported models in which effects of trauma on distress were mediated by current stressors. Although war-related traumatic events are the initial causes of refugees' hardship, findings suggest that the day-to-day challenges and concerns in camps mediate psychological distress associated with these events

The research on the determinants of mental health among refugees has been largely limited to traumatic events, but recent work has indicated that the daily hassles of living in refugee camps also play a large role. Using hierarchical linear modelling to account for refugees nested within camp blocks, this exploratory study attempted to model stress surrounding safety and acquiring basic needs and functional impairment among refugees from Darfur living in Chad, using individual-level demographics (e.g., gender, age, presence of a debilitating injury), structural factors (e.g., distance from block to distribution centre), and social ecological variables (e.g., percentage of single women within a block). We found that stress concerning safety concerns, daily hassles, and functional impairment were associated with several individual-level demographic factors (e.g., gender), but also with interactions between block-level and individual-level factors as well (e.g., injury and distance to distribution centre). Findings are discussed in terms of monitoring and evaluation of refugee services.

This paper seeks to bridge the divisive split between advocates of trauma-focused and psychosocial approaches to understanding and addressing mental health needs in conflict and post-conflict settings by emphasizing the role that daily stressors play in mediating direct war exposure and mental health outcomes. The authors argue that trauma-focused advocates tend to overemphasize the impact of direct war exposure on mental health, and fail to consider the contribution of stressful social and material conditions (daily stressors). Drawing on the findings of recent studies that have examined the relationship of both war exposure and daily stressors to mental health status, a model is proposed in which daily stressors partially mediate the relationship of war exposure to mental health. Based on that model, and on the growing body of research that supports it, an integrative, sequenced approach to intervention is proposed in which daily stressors are first addressed, and specialized interventions are then provided for individuals whose distress does not abate with the repair of the social ecology

Reply by the current authors to the comments made by Frank Neuner (see record 2010-19631-003) on the original article (see record 2009-23616-002). Their study offers a thoughtful commentary on our paper. Neuner, whose intervention research group generally fits within the trauma-focused approach, is primarily concerned with the lack of an evidence base for prioritizing psychosocial over trauma-focused interventions. Neuner challenges the basic premise of our paper by questioning the utility of distinguishing between war exposure and other types of stressors. Neuner has suggested that we are advocating empirically unproven intervention strategies in order to target social-ecological variables that are difficult to identify and may not be causally related to mental health anyway. In his view, treating PTSD using specialized, expert-driven interventions that have at least some empirical support is the appropriate role of mental health organizations working with conflict-affected populations. Neuner suggests that such a broad view is the norm among trauma-focused researchers, who he believes do not focus specifically onwar-related trauma, but consider the broad range of traumatic stressors to whichwar-affected populations may be exposed. We agree with Neuner that the term daily stressors is conceptually problematic, a point we discuss at some length in our original paper.

This study profiles the family-directed anger of traumatized Cambodian refugees, all survivors of the Pol Pot genocide (1975-1979), who were patients at a psychiatric clinic in Lowell, MA, USA. We focus on the nuclear family (NF) unit, the NF unit defined as the patient's 'significant other' (i.e. spouse or boyfriend/girlfriend) and children. Survey data were collected from a convenience sample of 143 Cambodian refugee patients from October 2006 to August 2007. The study revealed that 48% (68/143) of the patients had anger directed toward a NF member in the last month, with anger directed toward children being particularly common (64 of the 143 patients, or 49% [64/131] of the patients with children). NF-type anger was severe, for example, almost always resulting in somatic arousal (e.g., causing palpitations in 91% [62/68] of the anger episodes) and often in trauma recall and fears of bodily dysfunction. Responses to open-ended questions revealed the causes of anger toward a significant other and children, the content of anger-associated trauma recall, and what patients did to gain relief from anger. A type of cultural gap, namely, a linguistic gap (i.e., the parent's lack of English language skills and the child's lack of Khmer language skills), seemingly played a role in generating conflict and anger. NF-type anger was associated with PTSD presence. The effect of anger on PTSD severity resulted in part from anger-associated trauma recall and fears of bodily dysfunction, with 54% of the variance in PTSD severity explained by that regression model. The study: 1) suggests that among traumatized refugees, family-related anger is a major clinical concern; 2) illustrates how family-related anger may be profiled and investigated in trauma-exposed populations; and 3) gives insights into how family-related anger is generated in such populations

This study examined the validity and utility of PTSD among 320 adults in Afghanistan. Findings support the validity of PTSD in this cultural context: PTSD symptoms were highly prevalent, shared common variance, and correlated as expected with exposure to traumatic stress. However, only limited support was found for the clinical utility of PTSD. Other types of psychiatric symptomatology, including depression and a culturally specific measure of general distress, correlated more highly with traumatic stress than did PTSD; and PTSD accounted for limited variance in functioning beyond that explained by depression and general distress. Implications for research and intervention are considered

OBJECTIVE: Children of adolescent mothers are at increased risk of violence exposure and behavior problems, which have been linked to mothers' disciplinary practices. This study examines how the effect of young African American mothers' discipline on their preschool-age children's externalizing and internalizing behavior varies by mother and child violence exposure. METHODS: A sample of 230 African American mothers who gave birth as adolescents and their 3- to 6-year-old children were recruited from community-based day care and primary health care sites in the Washington, DC, metropolitan region. In-person interviews were conducted by trained research assistants who administered standard survey instruments. RESULTS: Hierarchical regression models revealed an interaction effect such that adolescent mothers' harsh disciplinary practices, specifically physical discipline strategies, were positively associated with young children's internalizing and externalizing behavior in the context of high or moderate, but not low, maternal violence exposure. CONCLUSIONS: Compared with less violence-exposed mothers, the harsh disciplinary practices of young African American mothers who have been exposed to high levels of violence are more strongly associated with their children's problem behavior. Practitioners should screen mothers for violence exposure in order to address potential issues of discipline and behavior problems

The lack of transparency in immigration detention in the United States has contributed to serious concerns about the fate of immigrants who are detained in the United States and require medical care. In particular, deficiencies in initial screening, chromic disease management (including referral to outside care), and pain management of detainees have been identified by numerous governmental and nongovernmental groups. We have identified a number of detainee deaths and poor medical outcomes that are related to substandard medical care and suggest system-wide problems in US Immigration and Customs Enforcement (ICE) health care. This article provides an overview of the current ICE health care system, presents four cases of detainee deaths and independent reporting of similar systemic problems, and recommends several specific changes to the ICE health care system.

Working in Afghanistan's capital city of Kabul, the authors assessed the relative contribution of daily stressors and war-related experiences of violence and loss to levels of depression, PTSD, impaired functioning, and a culturally specific measure of general psychological distress. For women, daily stressors were a better predictor than war experiences of all mental health outcomes except for PTSD; for men, daily stressors were a better predictor of depression and functional impairment, while war experiences and daily stressors were similarly predictive of general distress. For men, daily stressors moderated the relationship between war experiences and PTSD, which was significant only under conditions of low daily stress. The study's implications for research and intervention in conflict and post-conflict settings are considered