Post-traumatic stress disorder and life events among recently resettled refuges

Background In refugee health, one topic is how important posttraumatic stress disorder (PTSD) is from a public health point of view. The present study was initiated in order to study the prevalence of PTSD through structured assessment in a group of recently resettled refugees, to study important classes of present life events and their interaction with health by means of qualitative and quantitative methods as well as hormonal markers. Further, associations between traumatisation, PTSD and alexithymia were of interest. Subjects and methods Participants eligible for the study were 18-48 years old recently resettled refugees from Iraq with at least five years of school. Eighty-six out of 321 eligible subjects participated. The study was prospective in design and used questionnaires in order to collect information about life events and self-reported health at baseline and three follow-up assessments every three months. At the same time, blood samples were collected and stored. At the end of data collection, samples were analysed for cortisol, thyroxine, prolactin, and dehydroepiandrosterone sulphate (DHEA-s). Participants were screened with a specific health interview, and subjects exceeding a low cut-off score - 75/86 - were examined with structured clinical assessment for posttraumatic stress disorder. Questionnaires were translated into Arabic and South Kurdic and back-translated. Results The prevalence of PTSD among the participants was 37,2 % and was higher among males than females, consistent with lower self-reported trauma exposure among females. The significant life events of importance for present health were distress in significant others, concerns related to issues of family reunion, and inordinate demands in the introduction programme. Housing problems were associated with deteriorated health in PTSD subjects. The pattern of cortisol changes was the same in PTSD and non-PTSD subjects, whereas there was an interaction with PTSD for DHEA-s. PTSD was associated with higher alexithymia score, but this was related to increased dysphoric affect. The health screening interview was without complications. Subjects with difficulties concentrating were 23 times more likely to have a PTSD diagnosis. Conclusions PTSD is prevalent in refugees. During the observation period, factors such as housing problems and self-perceived inordinate demands were associated with deteriorated health markers. Vulnerable subjects are easy to identify, and self-reported distress predicts deteriorated health. Distress in significant others abroad is a very prevalent stressor, and concern for significant others in the home country is thus a factor of importance for mental health in refugee populations. According to the longitudinal analysis, DHEA-s and related steroid molecules could be associated with patophysiology in PTSD. Recent life events are important for present health status of refugees and interact with previous traumatic experiences

Psychophysiological assessment of trauma-focused Group Music and Imagery therapy for women with PTSD or CPTSD using script-driven imagery. A randomised controlled study

Background In posttraumatic stress disorder (PTSD), physiological reactions during trauma scripts have been anchored to the diagnosis. According to the construct of research domain criteria, physiological reactions and self-rating scales could be used to evaluate treatment effects. Objective In the present study, self-rated PTSD symptoms combined with physiological reactions during trauma script were used as outcome measurements in the domain of arousal/regulatory systems in a controlled randomised study of Group Music and Imagery (GrpMI) treatment for females with PTSD or complex posttraumatic stress disorder (CPTSD) related to violence and/or sexual abuse. Methods 45 traumatised women were randomised to 12 weeks of active treatment or waiting. Before and after the intervention, an assessment was done using physiological measurements during script-driven imagery (SDI) procedures. Subjective Units of Distress (SUD) were collected immediately after the trauma script (TS). Reactions during the SDI procedure were reported using the Responses to Script Driven Imagery (RSDI) scale, measuring re-experiencing, avoidance, and dissociation. Self-reported PTSD symptoms were accessed using the PTSD checklist for DSM-5 (PCL-5). Heart rate (HR), heart rate variability (HRV), and electrodermal activity were sampled during the baseline (BL) and TS conditions of the SDI procedure. As a measure of trauma-related reactivity, the difference between TS and BL was used for statistical calculations. HRV measures included high (HF; 0.15-0.4 Hz) and low (LF; 0.03-0.15 Hz) frequency band power, the LF/HF ratio, and the root mean square of successive inter-beat differences (RMSSD). Measures of electrodermal activity included skin conductance levels (SCL) and frequencies of non-specific skin conductance responses (NS-SCR). Further, correlations between self-rated PTSD symptoms and physiological reactivity measures were analysed. Results During the TS, the absolute levels of HR, LF/HF-ratio, and NS-SCR, as well as the trauma-related reactivity of HR, RMSSD, HF, LF/HF-ratio, SCL, and NS-SCR, showed significant changes indicating decreased arousal during trauma script after treatment. Compared to the waitlist control, an interaction analysis showed significant treatment effects in the BL level of HR, the absolute TS level of HR and HF, and the trauma-related reactivity of RMSSD and HF, suggesting an improvement of vagal function in the treatment group. Significant treatment-related reductions were found in symptoms of PTSD, re-experiencing and avoidance, as well as SUD. The changes pre- to post-treatment in HR reactivity and self-rated PTSD symptoms correlated significantly. Furthermore, the initial HR reactivity predicted treatment outcome as measured with PCL-5. Conclusion In the evaluation of treatment methods for PTSD, a combination of self-report and physiological measures seems to be feasible. The physiological measures, in combination with a robust decrease in self-rated PTSD symptoms, indicate that trauma-focused GrpMI is a promising treatment for PTSD or CPTSD. More studies are needed to confirm the results, and further research comparing with other active treatments is necessary to establish the precise role of the treatment

Patterns of endogenous steroids in apathetic refugee children are compatible with long-term stress

BACKGROUND During the last few years, a number of children of asylum applicants in Sweden developed an apathetic or unconscious state. The syndrome was perceived as new, and various explanations were advanced such as; factitious disorder, intoxication, or stress. Considering a potential association between traumatic stress and regulation of steroids biosynthesis, this study explored whether changes in concentrations of endogenous steroids were associated with the above syndrome. METHODS Eleven children were recruited in the study. Concentrations of steroids in blood samples were determined using high sensitivity liquid chromatography tandem mass spectrometry methods. Symptoms were assessed with a clinical rating scale developed for the study. Steroid concentrations were measured at the entry into study and after recovery; and concentrations were evaluated for the association with the symptoms in apathetic children. RESULTS  Cortisol and cortisone concentrations at baseline were negatively associated with duration of the symptoms from entry into the study to clinical recovery. Concentrations of pregnanes (pregnenolone, 17-OH-pregnenolone, and dehydroepiandrosterone) and 17-OH-progesterone were increased in the symptomatic state and decreased after the recovery. CONCLUSIONS  Pattern of low cortisol concentrations found in apathetic children is consistent with long-term stress. An increase of upstream steroid metabolites such as pregnanes and 17-OH-progesterone was found to be associated with the symptomatic state

Patterns of endogenous steroids in apathetic refugee children are compatible with long-term stress

BACKGROUND During the last few years, a number of children of asylum applicants in Sweden developed an apathetic or unconscious state. The syndrome was perceived as new, and various explanations were advanced such as; factitious disorder, intoxication, or stress. Considering a potential association between traumatic stress and regulation of steroids biosynthesis, this study explored whether changes in concentrations of endogenous steroids were associated with the above syndrome. METHODS Eleven children were recruited in the study. Concentrations of steroids in blood samples were determined using high sensitivity liquid chromatography tandem mass spectrometry methods. Symptoms were assessed with a clinical rating scale developed for the study. Steroid concentrations were measured at the entry into study and after recovery; and concentrations were evaluated for the association with the symptoms in apathetic children. RESULTS  Cortisol and cortisone concentrations at baseline were negatively associated with duration of the symptoms from entry into the study to clinical recovery. Concentrations of pregnanes (pregnenolone, 17-OH-pregnenolone, and dehydroepiandrosterone) and 17-OH-progesterone were increased in the symptomatic state and decreased after the recovery. CONCLUSIONS  Pattern of low cortisol concentrations found in apathetic children is consistent with long-term stress. An increase of upstream steroid metabolites such as pregnanes and 17-OH-progesterone was found to be associated with the symptomatic state

Adverse Childhood Experiences are associated with choice of partner, both partners' relationship and psychosocial health as reported one year after birth of a common child : A cross-sectional study

Adverse Childhood Experiences (ACEs) are common and known to have consequences for individuals' adult health, leading to a higher risk of illness. The aims of the study were to investigate the ACEs in couples, to examine the extent of assortative mating and to investigate the association between the relationship of the load of ACEs within couples and health outcomes, one year after the birth of a common child. At antenatal clinics in Sweden 818 couples were recruited and investigated one year after the birth of a common child answering a questionnaire including the exposure to ten ACE categories and several outcome variables. In total, 59% of both mothers and partners reported exposure to at least one of the ten ACE categories. Among the mothers 11% and among the partners 9% reported exposure to ≥4 ACE categories (p = 0.12). There was a correlation between the numbers of ACE categories reported by the mothers and their partners (Spearman's ρ = 0.18, p<0.001). This association pertained to six of the ten ACE categories. In multiple logistic regression analyses, there were associations between the ACE exposure load and unfavourable outcomes among the mothers, the partners and within the couples. Unfavourable outcomes concerning health were most prominent in couples where both members reported exposures to ≥4 ACE categories (self-rated bad health (OR 13.82; CI 2.75-69.49), anxiety (OR 91.97; CI 13.38-632.07), depression (OR 17.42; CI 2.14-141.78) and perceived stress (OR 11.04; CI 2.79-43.73)). Mothers exposed to ACEs tend to have partners also exposed to ACEs. Exposure to ACEs was associated with bad health and unfavourable life conditions within the couples, especially among couples where both members reported exposure to multiple ACEs. These results should stimulate incentives to find, to support and to treat individuals and couples where both members report multiple ACEs. The consequences for the children should be further studied as well as how these families should be treated in health care and society

Assault characteristics of PTSD versus Non-PTSD group.

<p><i>Note.</i> Pearsons chi-test for categorical variables presented in percent. OR = odds ratio. CI = confidence interval. *p<.05. **p<.01.***<.001.</p><p>Assault characteristics of PTSD versus Non-PTSD group.</p

Psychometrics at baseline of PTSD versus Non-PTSD.

<p><i>Note.</i> Independent t-test for continuous variables presented in means (M) and standard deviations (SD). Pearsons chi-test for categorical variables presented in percent. OR = odds ratio. CI = confidence interval. BDI = Beck Depression Inventory. SASRQ = The Stanford Acute Stress Reaction Questionnaire. PDS = The Posttraumatic Stress Diagnostic Scale. *p<.05. **p<.01.***<.001.</p><p>Psychometrics at baseline of PTSD versus Non-PTSD.</p

Victim characteristics of PTSD versus Non-PTSD.

<p><i>Note.</i> Independent t-test for continuous variables presented in means and standard deviations (SD). Pearsons chi-test for categorical variables presented in percent. OR = odds ratio. CI = confidence interval. *p<.05. **p<.01. ***<.001.</p><p>Victim characteristics of PTSD versus Non-PTSD.</p